Preamble

The House met at half-past Two o'clock

PRAYERS

[MR. SPEAKER in the Chair]

PRIVATE BUSINESS

STRATHCLYDE REGIONAL COUNCIL ORDER CONFIRMATION BILL

Considered; to be read the Third time.

Oral Answers to Questions — EMPLOYMENT

Labour Statistics

Dr. Thomas: To ask the Secretary of State for Employment what was the unemployment rate in Worcester in (a) 1979, (b) 1984 and (c) 1989.

The Minister of State, Department of Employment (Mr. Tim Eggar): Between 1984 and 1989 the rate of unemployment, unadjusted, for the Worcester travel-to-work area fell from 11·2 per cent. to 4·5 per cent. Worcester travel-to-work area, as currently defined, did not exist in 1979.

Dr. Thomas: I am grateful to the Minister for that reply. Will he confirm that that decline is greater than the reduction in unemployment achieved in Wales during the comparable period? Are the employment policies pursued by the Welsh Office and by his Department identical? If the Secretary of State for Employment was to succeed the Secretary of State for Wales, would those policies continue?

Mr. Eggar: The hon. Gentleman has a close personal interest in the future of my right hon. Friend the Secretary of State for Wales in relation to both their voting records. From January 1989 to January 1990, unemployment fell by 22·4 per cent. in Wales whereas in the United Kingdom as a whole it has fallen by 18·7 per cent. Wales has done considerably better than the United Kingdom over that period.

Mr. Nicholas Bennett: Will my hon. Friend confirm that unemployment in Wales has fallen by 150,000 as a result of inward investment and that that achievement is due in great part to the efforts of my right hon. Friend the Secretary of State for Wales? I am sure that the people of Worcester, too, would like to thank my right hon. Friend the Secretary of State for Wales for his efforts.

Mr. Eggar: I agree completely with my hon. Friend. The hon. Member for Meirionnydd Nant Conwy (Dr. Thomas) also agrees, because he described my right hon. Friend as the best Secretary of State that Wales has ever

had. In response to the question of my hon. Friend the Member for Pembroke (Mr. Bennett), more people are employed in Wales than ever before.

Mr. Sumberg: To ask the Secretary of State for Employment by what amount the level of unemployment in the north-west of England has changed over the last three years for which figures are available.

The Secretary of State for Employment (Mr. Michael Howard): Between January 1987 and January 1990 seasonally adjusted unemployment in the north-west region has fallen by 179,000 or 43 per cent.

Mr. Sumberg: Does my right hon. and learned Friend recall that at the previous general election the Labour party promised to reduce unemployment by 1 million inside two years? Does he recognise that we have achieved that and more inside a shorter period? Does he agree that the best hope for the north-west, whose economy is booming, is a continuation of this Conservative Government?

Mr. Howard: My hon. Friend is absolutely right. We made no such specific pledges at the election, but we beat the Labour party's promise by two months. Unemployment has continued to decline since, and my hon. Friend correctly attributed that to the success of the Government's policies.

Mr. James Lamond: Is the Minister aware that in January there were 7,500 unemployed men and women in Oldham, that the number has increased since and that it is likely to increase even more unless his Department puts pressure on his colleagues to ensure that the multi-fibre arrangement is renewed and textiles are protected?

Mr. Howard: The hon. Gentleman knows very well the attitude of my right hon. and hon. Friends to that matter. We must look at the whole employment picture in the north-west, which, as I said to my hon. Friend the Member for Bury, South (Mr. Sumberg), is a very bright one.

Mr. Hind: Does my right hon. and learned Friend agree that the fall in unemployment of 179,000 in the north-west is due in no small way to the vigorous policy of inward investment operated by the Department of Trade and Industry and to his Department's strong small business policy which have created thousands of new businesses and brought in much new investment from overseas?

Mr. Howard: I am always happy to pay tribute to my right hon. Friend the Secretary of State for Trade and Industry, and I agree entirely with my hon. Friend's observations. It is easy to overlook the important contribution that inward investment makes to sustaining our excellent employment record.

Mr. Blair: As he surveys the background to the Budget next week—we have the highest real interest rates of any of our main competitors, the worst inflation record, the worst balance of payments deficit, and training gaps and skills shortages—can the right hon. and learned Gentleman tell us when unemployment will get back down to the level that the Government inherited in 1979?

Mr. Howard: The hon. Gentleman should be aware, but perhaps is not, that there are 1·5 million more people in


work now than in 1979. That is the answer to his grossly extravagant claims, and that excellent record is the result of this Government's policies.

Mr. Couchman: To ask the Secretary of State for Employment what is the latest figure for the total work force in employment in the United Kingdom.

Mr. Howard: In September 1989 the work force in employment in the United Kingdom was 26,955,000—the highest level ever. This represents an increase of 3,391,000 since March 1983.

Mr. Couchman: I am grateful to my right hon. and learned Friend for those figures. As he said, it proves that 1·5 million more people are in work now than in 1979. Will my right hon. and learned Friend point out our job creation record to our European partners who would foist upon us a social charter?

Mr. Howard: My hon. Friend makes a most important point. We are determined not to have inflicted upon us policies that would undo our achievements since 1979. Those achievements are due to our policy of lower regulation and the freeing of enterprise. Many of our European colleagues have much to learn from that.

Mr. Duffy: It is not difficult for the Secretary of State to comfort one of his hon. Friends from the south-east on a question such as this, although I note that he did not point out that two thirds of the increase in jobs last year was represented by part-time jobs. What does the Secretary of State say to an hon. Member from the north of England—from, say, the Sheffield travel-to-work area—where the number of registered claimants in January rose for the second month running?

Mr. Howard: Unlike Opposition Members, Conservative Members do not denigrate part-time work, which we believe has an important part to play in improving prospects for employment. The hon. Gentleman is aware that during the past few years unemployment has been falling in the north at least as fast as in other parts of the country, if not faster. Prosperity is spreading to all parts of the country.

Mr. Ian Taylor: Does my right hon. and learned Friend agree that one reason for the high number of people in work is the bonfire of controls over industry and the enormous benefits from reducing corporation tax levels, especially for smaller firms? Will he try to explain that to the Opposition, some of whose emergent policies would throttle British business and increase unemployment?

Mr. Howard: My hon. Friend is absolutely right. The task of explaining these matters to the Opposition is very difficult, but we must never give up trying.

Mr. Alton: Notwithstanding the welcome improvement in unemployment figures, does the Secretary of State accept that the numbers of long-term unemployed people in some parts of the country, including the pockets of unemployment in Liverpool, remain stubbornly high? Does he further accept that when chambers of commerce make representations about the impact of the Channel tunnel on the more disparate regions of England, it could have a detrimental effect on employment patterns? What consideration is the right hon. and learned Gentleman giving to that?

Mr. Howard: The hon. Gentleman is right that there are still pockets where long-term unemployment is too high, although long-term unemployment has been falling faster than unemployment generally. The Channel tunnel will benefit all parts of the country. I hope that when the hon. Gentleman talks about the effects of Government policies on unemployment, particularly in Liverpool, he will pay full tribute to the uniform business rate, which will go a long way to improving employment prospects in his area.

Tourism

Mr. Franks: To ask the Secretary of State for Employment what was the increase between 1988 and 1989 in expenditure in Britain by overseas visitors.

The Parliamentary Under-Secretary of State for Employment (Mr. Patrick Nicholls): It is provisionally estimated that overseas residents spent £6,850 million in the United Kingdom during 1989, 11 per cent. more than in 1988.

Mr. Franks: Will my hon. Friend confirm that last year was the third record year in a row for the tourist industry? Will he also confirm that more than 1·5 million people work in the industry? Does he agree that the Opposition's attitude to tourism is an insult to the people who work in it?

Mr. Nicholls: My hon. Friend is entirely right to draw our attention to the fact that tourism is a highly vibrant industry. About 17·2 million visitors came to the United kingdom in 1989, and about 15·8 million in 1988. As my hon. Friend said, that is a record. It is welcome, especially for people working in the industry.

Mr. Eastham: The Minister mentions the importance of the tourist industry and the benefits to the nation, but I draw his attention to the miserable amount of money that the Government spend on promoting tourism in Britain. The sum of about £50 million is just petty cash compared with the potential earnings for the nation.

Mr. Nicholls: When one looks at the facts, rather than the rhetoric, one sees that in 1991 the British Tourist Authority will receive £27·7 milion and the English tourist board will receive about £14·5 million. Those are increases of 11 per cent. and 9 per cent. respectively. Where the hon. Gentleman goes wrong is in believing that an extremely thriving, mostly private sector industry could be helped by the dead hand of the state. Those days are gone and it is time the hon. Gentleman caught up.

Mr. Gregory: Does my hon. Friend remember the figures under the Labour Government in 1978–79, when tourism was derided as a candy floss industry good enough only for Mickey Mouse? Could not we further increase expenditure if we put out tourist information centres to competitive tender and concentrated, in this European Year of Tourism, on foreign languages?

Mr. Nicholls: In an industry as successful as this, the good ideas will keep on coming. I agree entirely with my hon. Friend that tourism has done extremely well under the Government. It comes badly from the Opposition to pledge their support for tourism but to deride jobs in the service industries.

Mr. John D. Taylor: I welcome the extension of foreign tourism in the United Kingdom. Does the Minister agree that it usually coincides with the success of the Government's policies and a decline in the exchange rate of the pound sterling?

Mr. Nicholls: I am not sure whether I can comment on that. The important point is whether we consider the industry in terms of overseas tourism of our citizens or of overseas citizens coming here. The industry is buoyant and has done extremely well under the Government.

Training

Mr. Quentin Davies: To ask the Secretary of State for Employment what proportion of firms with 10 or more employees provide training.

Mr. Michael Howard: The latest survey carried out by my Department shows that 80 per cent. of firms with 10 employees or more provided training for their employees in 1986–87. The survey excluded agriculture and the armed services.

Mr. Davies: Does my hon. Friend agree that those figures are most encouraging for the future? Do not they give the lie effectively to the charge that is often made that British employers are not willing to provide training?

Mr. Howard: My hon. Friend is right. A total of £33 billion was spent on training in 1986–87, and the amount spent by employers has increased substantially.

Mr. Cryer: When the Minister calculates the amount spent on training, will he include in this year's figure the £11 million given to Astra Training Limited and the land which was passed to Astra, valued at almost £100 million, on which the skill centres are situated? That was a complete break with the policies set out in the Deloitte Corporate Finance Ltd. document issued on behalf of the Department of Employment. When will this ramp of taxpayers' money be given the publicity that it so richly deserves?

Mr. Howard: That money was made available to ensure that Astra could continue training at those skill centres. It represents an excellent agreement for the taxpayer and those who will continue to get training at the skill centres concerned.

Mr. Paice: Does my right hon. and learned Friend agree that the increase in expenditure on training demonstrates the Government's increasing commitment and the fact that, in addition to the substantial success of the training and enterprise councils, the more control employers have over the delivery of training, the more their commitment will be and the better it will be for the long-term future of the British work force?

Mr. Howard: I agree entirely with my hon. Friend. Training and enterprise councils represent the most exciting initiative ever in training. I am delighted with their progress and my hon. Friend is absolutely right to recognise it.

Mr. McLeish: Is the Secretary of State aware that the 1989 labour force survey has just been published? Why, after 11 years of indifference and inactivity, do only 14 per cent. of British employees receive any form of either on or off-the-job skills training? Will he concede that we are in

the second division for skills training—and not seeking promotion to the first division, but trying to avoid relegation to the third?

Mr. Howard: I congratulate the hon. Gentleman on drawing on his footballing past for the analogy in his question. I do not accept the suggestion of second division status in any respect. The latest labour force survey statistics show a substantial increase in the number of employees in receipt of training. We propose to build on that increase, and the training and enterprise councils will ensure that we succeed.

Disabled People

Mr. David Nicholson: To ask the Secretary of State for Employment how many disabled people were helped into jobs by his Department's programmes in 1988–89.

Mr. Eggar: In 1988–89, an estimated 77,200 people with disabilities were placed into jobs by jobcentres. In addition, many found jobs by other means following participation in other Department of Employment programmes.

Mr. Nicholson: Does my hon. Friend acknowledge that the figure that he has just announced is an impressive witness to the work undertaken by his Department to help the disabled? I say that with particular pleasure because 22 years ago I was a junior official in the Department. Will he continue to give a high priority to helping people with disabilities to get and keep work?

Mr. Eggar: I shall certainly draw my hon. Friend's remarks to the attention of the officials in my Department concerned with disabilities. The evidence of increased commitment can be seen in several ways, one of which is by looking at the increase in expenditure. In 1986–87 we spent £220 million on help to the disabled in employment and now we spend about £350 million.

Mr. Hannam: Is my hon. Friend aware that it is two years since his Department commissioned an important review into employment services for disabled people? When will the report be published?

Mr. Eggar: My hon. Friend and many other right hon. and hon. Gentlemen await the publication of the consultative document, and we are doing our best to produce it as soon as possible. We have decided that it would not be appropriate to publish it before we know the results of the survey of people with disabilities in the labour market. That has been commissioned and is being completed. We hope to be able to publish the consultative document in June this year.

Unofficial Strikes

Mr. Dickens: To ask the Secretary of State for Employment what proportion of industrial action taken in Britain is unofficial action.

Mr. Nicholls: A recent special exercise showed that in 1988 approximately one half of all stoppages and one third of all working days lost resulted from unofficial disputes.

Mr. Dickens: Does not the common sense vote by the ambulance workers to return to work illustrate how awful it would be if there were an unofficial strike by pockets of ambulance workers? Does my hon. Friend agree that it


says much for the Employment Bill which is going through the House of Commons that it would make such wildcat strikes illegal?

Mr. Nicholls: My hon. Friend is entirely right to draw the House's attention to the provisions in the Employment Bill which will require trade unions to say whether they support industrial action in particular cases. It is interesting that in Committee Opposition Members did everything that they could to defend the rights of unofficial strikers.

Mr. Heffer: In view of the ambulance workers' decision, why could not the Government have settled the dispute much earlier without the problems that have been caused? In relation to unofficial strikes, does the hon. Gentleman want workers to become wage slaves who must accept work whether they like it or not? The last right that ordinary working people have is the right to say no if they do not want to work for a particular employer in certain circumstances. By denying that, the Government are taking away a basic human right.

Mr. Nicholls: That really is the voice of the day before yesterday. It is remarkable that at a time when the citadels of state Socialism are crumbling all over Europe, the hon. Gentleman can get up and make a remark like that in favour of unofficial action. I should have thought that people who claim even a passing acquaintance with the trade union movement would be prepared to say that unofficial action should not be supported, but, to be frank, I never thought that the hon. Gentleman would take that view.

Mr. Janman: Does my hon. Friend agree that the vast majority of the British people are sick and tired of having to suffer at the hands of those who choose unofficial action, particularly in the public sector, and that the vast majority of the British people are thankful that at long last the Government have decided to do something about the problem? Does he agree that the attitude of Opposition Members in Committee, who continually opposed the progress towards this change in the law, is to be condemned and means that they are totally unfit to form a Government?

Mr. Nicholls: My hon. Friend is entirely right. If anyone wants evidence of the fact that Labour is the striker's friend, as it always has been—[HON. MEMBERS: "Disgraceful!"]—he could do much worse than read the reports of what was said in Committee. As hon. Gentlemen have just admitted, it is quite disgraceful.

Mr. Wallace: The Minister referred to the crumbling citadels of Socialism in eastern Europe. Does he accept that some of those citadels crumbled because of the type of unofficial action that the Government are making unlawful?

Mr. Nicholls: That was a question of remarkable puerility, even for the hon. Gentleman. It would be interesting for anyone who thinks that the alliance might live again to examine the hon. Gentleman's voting records and see how many times he had to side with the Opposition in Committee.

Women Workers

Mr. Leighton: To ask the Secretary of State for Employment what further steps the Government are taking to develop child care facilities to ease the path of women into employment.

Mr. Howard: The provision of child care facilities is primarily a matter for employers. Ministers have recently taken a number of practical initiatives to encourage the development of good quality child care provision.

Mr. Leighton: That inadequate reply will cause disappointment in many parts of the House. Does the Secretary of State understand that child care is an idea whose time has come, because the overwhelming majority of new entrants to the labour market will be women? We shall recruit them only if we take the right steps now. The Government should not have a hands-off policy—standing back and leaving it to everyone else—but should take the responsibility for creating a comprehensive nationwide system of child care. That will not come cheap, but the Government should bear the largest burden because they will recoup in extra income tax, national insurance contributions and value added tax much of the money that they would have spent on a child care system.

Mr. Howard: I agree with much of what the hon. Gentleman said about the importance of making provision for women who wish to return to work. The labour force survey, which was published at the end of last week, shows a dramatic increase in the number of women at work and is evidence that women are returning to work in ever-growing numbers. However, I do not think that, on reflection, the hon. Gentleman would suggest that the Government should assume responsibility for the wide-ranging measures to which he referred. That is primarily a matter for employers, who are increasingly recognising their responsibilities.

Mr. Rowe: Does my right hon. and learned Friend accept that a high proportion of women who return to work are employed by small companies which are incapable of providing the type of child care facilities that women need? Will he assure us that his Department is studying the whole range of possibilities, such as vouchers and other mechanisms, by which such women can be attracted back? There is already an excellent precedent in the employment training facility.

Mr. Howard: I note what my hon. Friend says. I am sure that employers are looking increasingly at precisely the type of facilities to which he referred. However, the primary responsibility must be theirs.

Mrs. Mahon: Is not the local authority the best provider of child care? It knows what local people want. If local authorities were given the resources, they would be the best provider of child care. That would stop kids being dragged about in the early hours of the morning on buses and other forms of transport. Why does not the Minister accept his responsibilities as a member of the Government? If it could be done during the war, why cannot it be done now?

Mr. Howard: I am afraid that I cannot share the hon. Lady's views about the omniscience of local authorities. Therefore, I cannot agree with her suggestion.

Mrs. Peacock: Will my right hon. and learned Friend confirm that more women are working in this country than in any other European country? Although many of those jobs are part time, which the Opposition deride, does he accept that many want part-time work because it fits in with their family responsibilities?

Mr. Howard: My hon. Friend is absolutely right on both counts. I take some comfort from the Select Committee's recent report on part-time work. It paid particular tribute to the record of my Department, which makes part-time work available to virtually everyone who is appropriately qualified to do the job in question.

Health and Safety

Mr. Andrew F. Bennett: To ask the Secretary of State for Employment when he last met the director-general of the Health and Safety Executive; and what was discussed.

Mr. Nicholls: My right hon. and learned Friend met the director-general of the Health and Safety Executive, together with the chairman of the commission, on 31 January for a discussion on the work of the commission and the executive.

Mr. Bennett: Does the Minister accept that there are still far too many accidents at work, and that, tragically, far too many people are still killed at work? What steps will the Health and Safety Commission take to protect in particular the increasing number of part-time workers who have great difficulty in making representations to their employers about their working conditions, if they are dangerous?

Mr. Nicholls: The first part of the hon. Gentleman's question was entirely right. I am sure that that is accepted on both sides of the House. As for the Government's contribution to the funds that are needed, during the past three years we have met the HSE bill in full. The HSE's consultative document relating to those who work on multi-contractor sites goes a considerable way towards addressing the hon. Gentleman's concerns.

Sir Dudley Smith: Is my hon. Friend aware that during the past 20 years there have been significant improvements in health and safety at work in this country and that we compare favourably with all other countries, particularly the advanced ones? Is he further aware that if we become too draconian, that can eventually be counterproductive? Will he please tell that to the director-general?

Mr. Nicholls: My hon. Friend is right to remind us that standards are a great deal better than they used to be. However, they could be a great deal better in certain industries. I have in mind the construction industry and the self-employed. I am sure that my hon. Friend agrees with me that a great deal more needs to be done.

Mr. Speaker: Mr. Lloyd.

Mr. Tony Lloyd: rose——

Mr. Loyden: Why have the promises that were made to the docks industry——

Mr. Speaker: Order. I called the hon. Member for Stretford (Mr. Lloyd). I shall have to give the hon. Member for Liverpool, Garston (Mr. Loyden) another chance.

Mr. Lloyd: It was a small piece of ventriloquism, M r. Speaker.
When the Secretary of State met the director-general of the Health and Safety Executive, did he discuss the lack of new personnel to monitor the Control of Substances Hazardous to Health Regulations, the lack of specialist health and safety inspectors and the lack of a proper framework within which to do the health and safety work that the Minister says he wants to be done? That is not happening.

Mr. Nicholls: My right hon. and learned Friend has had wide-ranging discussions with both bodies. If the hon. Gentleman was trying to say, yet again, that a mere increase in the number of inspectors will automatically lead to an automatic decrease in the number of accidents, he would be disguising the fact that the responsibility for dealing with health and safety is ultimately the responsibility of those involved—both employees and employers.

Mr. Sayeed: Will my hon. Friend confirm that the Health and Safety Executive has been granted all the resources that it asked for, for this year and for the next two years? Does not that give the lie to the Labour party's propaganda?

Mr. Nicholls: I repeat to my hon. Friend what I said a moment ago in relation to the public expenditure survey over the past three years. Under this Government, spending in real terms is at least as good as it was under the previous Government. Opposition Members sometimes make the mistake of believing that all those problems could be solved by the mere expenditure of money. It is a beguiling notion. It would be good if it were true, but it Js not.

Disabled People

Mrs. Margaret Ewing: To ask the Secretary of State for Employment what proportion of the registered disabled adult population are currently in (a) full-time and (b) part-time employment.

Mr. Eggar: I regret that comprehensive information on the employment status of registered disabled people is not yet available. A study commissioned by my Department will provide comprehensive information about the numbers and characteristics of people with disabilities in the labour market.

Mrs. Ewing: We shall all be very grateful when those statistics are available. Does the Minister accept that previous surveys showed clearly that unemployment among disabled people—reaching about 19 per cent. in 1988—is much higher than among able-bodied people? Is not there a need to introduce programmes to educate employers into recognising that one disability does not mean general inability, so there should be discrimination to ensure that disabled people are offered posts for which they are qualified?

Mr. Eggar: The hon. Lady made some good points. I thank her for her recognition of the need for a


comprehensive analysis. There have been surveys, but, with regard to the type of job, the type of disability, and so on, they have been partial. We have decided to delay publication of the consultation document on the review, to enable us to take account of the study that is being carried out. That will be to the benefit of everybody who is interested in disability.

Mr. Bowis: Will my hon. Friend do what he can to remove the uncertainty that hangs over training establishments, such as the SHARE community, year by year? Without training, so many people cannot benefit from the job opportunities that are available to able-bodied people.

Mr. Eggar: Obviously, my hon. Friend understands how we make money available for training on a year-by-year basis. That is necessitated by the way in which my Department is funded. If my hon. Friend wishes to draw a particular point to my attention, I shall be very happy to meet him to discuss it.

Unemployment, Cornwall

Mr. Matthew Taylor: To ask the Secretary of State for Employment what is the latest unemployment rate in Cornwall; and what was the average figure in Cornwall in 1979.

Mr. Eggar: In January 1990 the rate of unemployment in the county of Cornwall and the Isles of Scilly was 10 per cent., compared with an average of 9·7 per cent. for 1979. Those figures are not adjusted to take account of seasonal influences or changes in coverage.

Mr. Taylor: The House may be aware of the recent announcement that one of the two remaining tin mines in my constituency and in Cornwall—the Wheal Jane tin mine—is to be closed. This is a matter mainly for the Department of Trade and Industry, which has been funding the mine. However, I hope that Employment Ministers will make a special effort to help with, and take into account, the employment problems that may arise in that immediate area as a direct result of closure, if it goes ahead, and as a result of spin-off losses.

Mr. Eggar: I am very sad to hear about those closure plans. I visited the mine, which, I think, is just outside the hon. Gentleman's constituency, some years ago. I understand what the hon. Gentleman is saying. However, I have to say that over the past year the fall in unemployment in his constituency has been sharper than the fall generally in the United Kingdom.

Health and Safety

Mr. Strang: To ask the Secretary of State for Employment whether he will make a statement on the Health and Safety Commission and Executive's annual report for 1988–89.

Mr. Nicholls: The report of the Health and Safety Commission and Executive was published on 26 February. Latest provisional statistics for 1988–89, published in the report, show an apparent levelling off of major injuries, which we very much welcome. But the number of fatalities, which include those from the Piper Alpha disaster, and

high or increasing injury rates in particular industries demonstrate that there is not room for any relaxation of effort by industry to improve standards.

Mr. Strang: In view of what the Minister said earlier, does he accept that no Opposition Member is suggesting that there is a direct, hard and fast relationship between the number of factory inspectors and the number of accidents? However, the report shows an unjustifiably high number of fatal accidents—something which was commented on at the press conference last month. Does the Minister accept that factory inspectors do very important preventive work, which improves the situation? Surely the Government must look at that again and take an initiative to increase the number of factory inspectors.

Mr. Nicholls: I can agree with a great deal of what the hon. Gentleman says. If he looks at the changes over the past two and a half years, he will accept that there has been a relatively late but welcome conversion to the proposition that mere inspector numbers do not automatically produce a decrease in accidents. Yes, inspectors have their place and, yes, that is why the HSE has been funded, but they are not the whole story.

Mr. Ian Bruce: As a result of the HSE report, has my hon. Friend found out whether the displaying of notices in all workplaces, giving the address and telephone number of the HSE, has ensured that employees and employers alert the HSE to many more cases of concern? Has my hon. Friend's Department looked in offices in the Palace of Westminster and seen how few seem to display those notices, which appears to be against the law?

Mr. Nicholls: I accept my hon. Friend's point about getting over to people the idea that there should be greater awareness of health and safety legislation. My hon. Friend asks me to pass judgment on a legal matter relating to the Palace of Westminster. I am tempted, but I shall decline.

Training and Enterprise Councils

Mr. Simon Hughes: To ask the Secretary of State for Employment how many corporate plans were submitted by 5 February and how many training and enterprise councils he anticipates giving approval to by 2 April.

Mr. Howard: Thirteen prospective training and enterprise councils have submitted their corporate plans and they are currently being considered. I am not prepared to speculate on the number that will begin operation on any particular date.

Mr. Hughes: The Secretary of State will be aware that many other hon. Members and I welcome the setting up of training and enterprise councils, but he will be aware also that they will be judged by their success. Will their corporate plans include targets for the number of traineeships, for the number of additional qualifications and for the reduction in the number of unemployed people as a result of the TECs? Does the right hon. and learned Gentleman realise that 50 per cent. and more of the work force has had no training? Does he agree that, unless that percentage is substantially reduced, any change in structure will be a failure, as many other initiatives have been?

Mr. Howard: I am grateful to the hon. Gentleman for his welcome for the TECs. I agree that they will be judged by their success. Not only will they be set targets, but a part of their income will depend on an assessment of their performance, and that is one reason why I am so confident that they will b a huge success.

Low Pay

Mr. Wigley: To ask the Secretary of State for Employment when he last met representatives from the Low Pay Unit; and what was discussed.

Mr. Nicholls: My right hon. and learned Friend has not met representatives from the Low Pay Unit.

Mr. Wigley: Does the Minister accept that those who are on low pay, many of whom are in the old industrial valleys and rural areas of Wales, are the very people who will be hardest hit by the poll tax? Those families will get no benefit from rebates. Will the hon. Gentleman take up this matter with the Chancellor of the Exchequer to ensure that, at the very least, the position of those people is safeguarded in that they will not be brought within the tax rate by the non-indexation of tax allowances?

Mr. Nicholls: As the hon. Gentleman says, there is a community charge rebate system. Some 7·5 million people will benefit from a rebate of up to 80 per cent. Obviously, everyone, including the Government, will watch with great interest how the scheme develops in practice.

Engineers

Mr. Rathbone: To ask the Secretary of State for Employment what steps he is taking to meet the demand for qualified engineers.

Mr. Eggar: It is a primary responsibility of employers to ensure that they attract, develop and retain qualified engineers. My Department, through the Training Agency, is taking action that will encourage employers to take a stronger lead in improving the supply of skills in industry, including engineering.

Mr. Rathbone: That action must be welcome. What liaison does my hon. Friend have with the Engineering Council to further its good work?

Mr. Eggar: I recently had the pleasure of discussing matters with the chairman of the Engineering Council, Sir William Barlow. The measures that we are introducing, including TECs, recognition of the important role of employers in defining vocational qualifications and our various initiatives to encourage business and education partnerships, will all help to improve engineering skills.

Health and Safety

Mr. Allen McKay: To ask the Secretary of State for Employment if he will make a statement on the Health and Safety Commission's annual report 1988–89.

Mr. Nicholls: I refer the hon. Gentleman to the reply I gave some moments ago to his hon. Friend the Member for Edinburgh, East (Mr. Strang).

Mr. McKay: Does the Minister agree that the greatest asset to industry is its work force and that the health and safety of that work force is of paramount importance? Is

the Minister satisfied with the number of health and safety inspectors, and with what is he doing to increase the powers and numbers of health and safety inspectors?

Mr. Nicholls: I accept what the hon. Gentleman said in the first part of his question and I pay tribute to the work of the inspectors. However, we must both accept that a mere increase in the number of inspectors is not the whole answer to the question, although it is a valuable contribution.

Oral Answers to Questions — PRIME MINISTER

Engagements

Mr. Gwilym Jones: To ask the Prime Minister if she will list her official engagements for Tuesday 13 March.

The Prime Minister (Mrs. Margaret Thatcher): This morning, I had meetings with ministerial colleagues and others. In addition to my duties in the House, I shall be having further meetings later today. This evening, I hope to have an audience of Her Majesty the Queen.

Mr. Jones: Does my right hon. Friend agree that it is an outrage for Members of this honourable House to incite others to break the law?

The Prime Minister: Yes, I totally agree with my hon. Friend. It is a negation of democracy and an appalling example to all young people, whom we urge to obey the rule of law, for without that, there can be no order. I welcome the condemnation by the right hon. Member for Islwyn (Mr. Kinnock) of the violence and of the 31 Opposition Members who have said that they will not obey the law. Those are his words and we now wait for him to follow them up with action.

Mr. Home Robertson: To ask the Prime Minister if she will list her official engagements for Tuesday 13, March.

The Prime Minister: I refer the hon. Gentleman to the reply that I gave some moments ago.

Mr. Home Robertson: We in Scotland—[Interruption.]—if the right hon. Lady does not mind my borrowing that phrase—are still waiting for the answers to many of the questions from which she ran away when she visited our country last week. Do she and her hon. Friends recall that 11 out of 21 Scottish Tory Members of Parliament lost their seats in 1987, largely because of the poll tax? As she managed to make the draw for the semi-finals of the Scottish Football Association competition a week before the qualifying matches took place, would she now like to draw the next batch of losers on her own Back Benches before she herself bales out?

The Prime Minister: I should like the right hon. Member for Islwyn (Mr. Kinnock) to take action on the 31 Opposition Members who are refusing to pay the community charge and to know from the hon. Gentleman whether he himself believes in upholding the law.

Mr. Onslow: If my right hon. Friend needs reassurance, which I doubt, may I assure her that last Sunday's press reports of polls and plots against her were absolute poppycock? [Interruption.]

Mr. Speaker: Order.

The Prime Minister: I thank my right hon. Friend—[Interruption.]

Mr. Speaker: Order. The House wants to hear the Prime Minister's reply.

The Prime Minister: I thank my right hon. Friend. I did not believe the reports anyway and thought that the usual source near to No. 10 Downing street, who dismissed them as bunkum and balderdash, got it absolutely right.

Mr. Cohen: To ask the Prime Minister if she will list her official engagements for Tuesday 13 March.

The Prime Minister: I refer the hon. Gentleman to the reply that I gave some moments ago.

Mr. Cohen: Will the Prime Minister respond to the report of the Policy Studies Institute, which showed that nearly 3 million households owed £3 billion by way of personal debt? As the poll tax will mean payments of 33 per cent. more than the rates cost last year and will represent an even larger burden on many families, and as mortgage rates are sky high and rents set to rise by 20 per cent., is the right hon. Lady aware that the Government are plunging people deeper and deeper into the red? Is she further aware that the British people are showing how fed up they are with being bled white and blue?

The Prime Minister: Nonsense. It will not have escaped the hon. Gentleman's notice that the rates of income tax are far below any that reigned in Labour's time in office, that they are now 25p in the pound as the standard rate and 40p in the pound as the upper rate. I remind the hon. Gentleman that if community charges are very high, that is the fault of Labour councils——

Hon. Members: What about Tory councils?

Mr. Speaker: Order. The Prime Minister.

The Prime Minister: It is—[Interruption.]

Mr. Speaker: Order. The House must not be disorderly. We must hear the Prime Minister's reply to supplementary questions.

The Prime Minister: It is quite clear that it always costs more under Labour.

Mr. Allason: Does my right hon. Friend think, given the Banking Acts' requirement that fit and proper people should hold banking licences, that the brothers Fayed should hold a banking licence at Harrods?

The Prime Minister: That is a matter for the regulatory authorities, not for me. The regulations are clearly laid down. How the law is applied is a matter for those authorities. How a prosecution happens is a matter for the Attorney-General, who answered questions on that matter yesterday.

Mr. Kinnock: With that last answer, the whole House will have noticed the right hon. Lady's choosy view of law and order——

Hon. Members: No.

Mr. Speaker: Order.

Mr. Kinnock: Will the Prime Minister give an assurance that, despite the continued rise in retail sales, the Government will not resort to higher interest rates yet again?

The Prime Minister: My answer to the right hon. Gentleman's first comment is that I should have thought that he would know that prosecution is never a matter for politicians—[Interruption.] He does not even know that. The day when a politician could institute prosecutions, the rule of law would end. The prosecuting authorities are independent and they are not politicians.
As for the figures of retail sales, which are up 2 per cent. on this time last year, I should point out that the previous year they were up by 4 per cent. and the year before that they were up by 8 per cent. So there is a steady progression downwards and therefore interest rates are working.

Mr. Kinnock: The Prime Minister should check the figures. This time last year the rise was 2·2 per cent., which is less than it has been in the last month. Does she not yet realise that her high interest rate policies are not controlling demand but are increasing inflation? That which she said would cure inflation is actually causing it. Will she admit that and not take a course that will add to the problems and make matters worse?

The Prime Minister: No. Retail sales this year are 2 per cent. above what they were this time last year. Last year they were 4 per cent. above what they had been the previous year, and the previous year the figure was 8 per cent. So there is a steady progression downwards in the growth of retail sales. There is no other way of getting inflation down than by increasing the price of money. If the hon. Gentleman reads what previous Labour Finance Ministers said, he will see that they took the same view.

Mr. Kinnock: Has not the Prime Minister grasped the idea that her policies are failing to manage demand? They are increasing inflation, decreasing manufacturing investment and clobbering every home buyer in the country. How is that helping to reduce inflation, which is an objective shared by all sensible people but not fulfilled by the Prime Minister and her policies?

The Prime Minister: But I thought that the right hon. Gentleman was complaining that demand in regard to retail sales is still pretty high. He cannot have it both ways. Either he is saying that people have no money, or he is saying that they have rather a lot, to make the retail sales higher than a year ago. In any case, we do not take lessons from the right hon. Gentleman on inflation, which rose under the previous Labour Government to 27 per cent.—a record for this century.

Mr. Churchill: Will my right hon. Friend spell out the consequences of any campaign of civil disobedience, as advocated by certain Opposition Members? Would not that starve local authorities of resources, thereby leading to tens of thousands of job losses in local government, and furthermore to the curtailment of services for the elderly and disabled? Is that what the Labour party wants?

The Prime Minister: My hon. Friend is absolutely correct. If people do not obey the law and pay their community charge—which is the fairest charge that we have ever had for local authorities, and is far fairer than the Opposition's alternative—the consequence will be that there will not be enough money for teachers or for


community care to look after old people and children. Such people would be wilfully damaging those whose interests they claim to represent.

Mr. Tony Lloyd: To ask the Prime Minister if she will list her official engagements for Tuesday 13 March.

The Prime Minister: I refer the hon. Gentleman to the reply that I gave some moments ago.

Mr. Lloyd: Is the Prime Minister aware that doctors in Manchester have now gone on record as saying that patients are dying because of a lack of intensive care beds? Those beds are not available because the authorities do not have the money to pay the trained staff. The Prime Minister normally gives us a long lecture at this point. Will she simply say what she intends to do to ensure that my constituents and those of my colleagues in that area do not die because of the lack of beds?

The Prime Minister: I can only say that more money has been made available by the taxpayer for the Health Service this year than ever before. This year, an additional £2·4 billion will be available, and next year there will be a further £3 billion. Altogether, that amounts to some £39 a week in respect of every family in the country. We look to regional and district health authorities to use that money well. We note that the great majority of them are able to do so, and provide services that most people find excellent.

Mr. Maples: Will my right hon. Friend find time today to congratulate the Labour-controlled council in Barking and Dagenham on having set a community charge of £280, which is just £2 over the Government's suggested figure? As that part of London is represented in the House by two shadow Cabinet members—one the chief spokesman on the environment—is not that an excellent example of what can be achieved, for them and us to present to other Labour-controlled councils?

The Prime Minister: My hon. Friend makes his point effectively. It is possible to live within the Government's guidelines for spending, and some Labour-controlled councils are already doing so. That only shows up the rest as deliberately trying to overspend to make it difficult for their residents.

Mr. Fearn: To ask the Prime Minister if she will list her official engagements for Tuesday 13 March.

The Prime Minister: I refer the hon. Gentleman to the reply that I gave some moments ago.

Mr. Fearn: With 2 million more people in debt and 400,000 people two months in arrears in rates and mortgage payments, and with the divorce rate almost doubling, does not the Prime Minister recognise that she is crucifying the women of this country and family life?

The Prime Minister: No. Far more people are in owner-occupied houses now than 10 years ago and there are more women with jobs now than there ever have been. Separate taxation for married women will be introduced on 1 April, again for the first time, and that will be welcome to many people.

Mr. Bowis: To ask the Prime Minister if she will list her official engagements for Tuesday 13 March.

The Prime Minister: I refer my hon. Friend to the reply that I gave some moments ago.

Mr. Bowis: Has my right hon. Friend had time to read the report of the National Society for the Prevention o Cruelty to Children, which links satanic practices with child abuse? Will she do everything in the Government's power to support the police and the child welfare agencies in stamping out such loathsome practices?

The Prime Minister: I saw the reports on the NSPCC report in the newspapers this morning. All hon. Members will be outraged that children may be sexually abused for the purposes of perversion or pornography, and everyone will be equally anxious to stamp that out. We have increased the penalties for child cruelty and we have tightened the law on child pornography by making possession of such material an offence. Tackling the problem remains a priority for the police, but we need evidence, and if people have evidence of cruelty to children they should not hesitate to place it before the police so that action can be taken as quickly as possible.

Arts Funding

The Minister for the Arts (Mr. Richard Luce): With permission, Mr. Speaker, I should like to make a statement about the structure of arts funding in England.
In December 1988 I commissioned a study of the system which exists for funding the arts in England through the Arts Council and the regional arts associations. My object was to ensure that we have the best funding structure for the arts in the 1990s.
The review was conducted by Mr. Richard Wilding, formerly head of the Office of Arts and Libraries, who presented his report to me in September 1989. Copies were placed in the Libraries of both Houses. I thank Mr. Wilding for his excellent work, a deep analysis of the problems and their possible solutions.
Following receipt of the report, I initiated an intensive period of consultation during which I received more than 6,000 written responses, had discussions with all interested parties and met several delegations of hon. Members and regional representatives.
I asked Mr. Wilding to pay particular attention to the following objectives: coherence between the national funding bodies and the regional arts associations in the formulation and delivery of policy; strengthening accountability for the public money spent by the regional arts associations; improving structures for the handling of business; considering the administrative cost of the whole system so as to get the best value for the arts.
Working on the basis of Mr. Wilding's recommendations, I have taken broad decisions that combine greater devolution with strengthened accountability.
First, I look to the Arts Council to formulate a national strategy for the arts and to monitor its operation throughout the country. The council will retain overall responsibility for strategic issues such as training, education, research, touring, innovation, broadcasting and international affairs. The Arts Council will continue to fund the national companies and some other organisations.
Secondly, I have decided that there should be a further shift in grant-giving responsibilities from the Arts Council to the regional arts associations. The associations will be responsible for most clients, although as the devolution process takes shape I shall need to be satisfied that it will both maintain and enhance standards of excellence throughout the country.
Thirdly, devolution to the regional arts associations will be accompanied by greater accountability for the larger sums of public money at their disposal, through a system of forward planning and budgeting under the direction of the Arts Council.
Fourthly, it will be important to have strongly based and well-resourced regional arts associations to deal with their enhanced responsibilities. The statistics show clearly that Merseyside Arts and Lincolnshire and Humberside Arts are, in terms of budget, population and the number of local authorities in the region, considerably smaller than the other 10 regional arts associations. I have, therefore, decided that, with effect from April 1991, Merseyside Arts should merge with North West Arts, Humberside should join Yorkshire Arts and Lincolnshire should become part of Eastern Arts.
I fully acknowledge the specific and unique cultural identity of Merseyside and the vital role that Merseyside Arts has played in the regeneration of the area. A regional arts office will be maintained in Liverpool for the foreseeable future, although Manchester will be the new regional headquarters.
Lincolnshire and Humberside Arts has also been a tireless promoter of the arts in its area. I shall ensure that satisfactory arrangements are made for the future well-being of the arts in Lincolnshire, and to preserve its cultural identity.
There will also be other boundary adjustments. The new regional arts associations will become regional arts boards. The chairman should be elected by the board and I have not accepted the recommendation that local authority councillors should be debarred from the chairmanship.
I recognise and welcome the important role of local authorities as funders of the arts, and I have decided they should have substantial representation on these new regional boards, provided it is less than a majority.
The Arts Council should have no more than 20 members. The number of regional representatives should be increased from three to five to reflect the enhanced role of the regional arts boards. Its decision will also be assisted by a newly established consultative body consisting of the chairman of the Arts Council, the chairmen of the Scottish and Welsh Arts Councils, and, if he so wishes, the chairman of the Arts Council of Northern Ireland.
Fifthly, the Crafts Council will remain an independent body. It should explore with the Arts Council ways of achieving closer co-ordination and co-operation to prevent duplication of effort. I am inviting the Crafts Council to reassess its corporate strategy in the light of my announcement.
Sixthly, I have set out more clearly defined roles for the British Film Institute.
Lastly, we should aim for the overall changes to be completed by April 1993. I am establishing a steering group to be responsible for implementing the changes. This group will report to me. I am pleased to announce the appointment of Mr. Timothy Mason, at present director of the Scottish Arts Council, to manage these reforms.
I have set out all these arrangements in more detail in a letter to the chairman of the Arts Council, a copy of which I have placed in the Libraries of both Houses.

Mr. Mark Fisher: We warmly welcome the Minister's announcement of a major devolution of power and responsibility from the Arts Council in London to the regions, but where is the new money, where is the investment, with which to take advantage of the opportunities which the Minister has quite correctly and positively created today?
Devolution is an essential step towards providing a structure for the expansion of the arts throughout this country in the 1990s, but it will be realised only if the Minister can back his structural alterations by showing similar courage and foresight in providing money.
The Minister has demonstrated that he has listened to the 6,000-odd representations that he has received from all over the country and to the, I understand, nearly 200 hon. Members who have written to him and with whom he has had meetings. We wish that more Ministers would listen so constructively to representations made to them, and we wish that more Ministers would take such an interest in


devolving power from the capital to the regions. We commend both those initiatives to his right hon. Friend the Prime Minister. She might well learn from the right hon. Gentleman.
We welcome the new strategic role for the Arts Council, but we have to ask how radical a devolution it is to be. We note that the Arts Council will retain the national companies and some other organisations. Will the Minister tell the House today how many other organisations, and which ones? Will it include the orchestras, Opera North, the English Stage Company and others? Does he accept that if he lengthens the list too much he will weaken the positive move towards devolution that he has announced? He has a difficult job there, and I think that the House needs to hear more from him on that.
We regret that the Minister has not had the courage to follow the logic of his devolutionary statement and allow all the regional arts boards to be represented as of right on the Arts Council. If he is serious about regional devolution, why will there be only five regional members out of 20 on the Arts Council? How will those five be determined, who will choose them, and why, if he is giving them more power, does he not trust the regions to have a voice and act in the national interest when they are represented on the Arts Council? Will there be an inner cabinet with this new consultative body that he is setting up? Will he tell the House rather more about the consultative inner group that he mentioned?
We are extremely enthusiastic about his belief in strongly based regions and we noticed that he said that they should be well resourced. We, of course, concur with that. They are not well resourced at the moment. Is he intimating that there will be new money?
I think that my right hon. and hon. Friends from Merseyside will require a great deal more from the Minister than the kind words and the cuts that we have had this afternoon. Will he explain and justify further his thinking behind picking out Merseyside and Lincolnshire and Humberside as the only areas that should be axed? Will he give positive reassurance to my hon. Friends and others about the local roots and contacts with companies in Merseyside and the expertise and skills in that regional arts association? Will he ensure that there are no job losses and that the structure can maintain the excellent cultural life of Merseyside and of Lincolnshire and of Humberside?
We are delighted that the Minister has given assurances that councillors will be eligible, as they should be, to be chairmen of regional arts bodies. We recognise that the important role of local authorities has been mentioned by the Minister. Will he say more about that? Does he join us in believing that the real expansion in the 1990s in our cultural life will come through local authorities? If so, how does that square with the poll tax?
On timing, we believe that this may be too slow. Will the Minister consider ways of speeding up the process, and who will bear the cost of the changes? It would be wrong to devolve and then ask the regions to bear all the costs for that decision. The regions will welcome the decision, but they should not bear the cost.
The House will note that there were two omissions from the Minister's statement. One is the mention of tiers, of which Mr. Wilding made great play. Will the Minister join us in confirming that the tier structure will not feature in his plans? What has happened to the federal structure to which Mr. Wilding referred?
This is an important day for the arts. The Minister has made a brave and good start on a framework for the arts in the 1990s, but he knows that new funding is needed not only for the national companies, which are acutely in deficit, but for the new opportunities that he has created in the regions. There is demand not only from the West Yorkshire playhouse and the Lyceum in Sheffield but from theatres in Cumbria and galleries and art centres all over the country. Will the Minister recognise that the poll tax could damage greatly what he is attempting to do in the regions? Will he take that on and fund arts at local government and regional level? If so, he will have the support of the whole House.

Mr. Luce: I am grateful to the hon. Gentleman, if I understood him aright, for his general support for the statement on the structure of funding for the arts into the 1990s and into the next century. It is very important for it to be coherent and to get the right structure so that it commands the confidence of the arts world and of Parliament.
On the hon. Gentleman's point about devolution, does he remember that just before Christmas he was generous enough to congratulate the Government on the 24 per cent. increase in the next three years in the total amount of financial support for the arts? If that is not a commitment by the Government to the arts, what is? That is a substantial commitment against the background of three-year funding which has been introduced for the first time.
On the scale of devolution, if, when the hon. Gentleman has time, he studies the letter which I have sent to Mr. Palumbo, the chairman of the Arts Council, he will see the broad guidelines that I have set for devolution. A copy of that letter is in the Library. Broadly speaking, I accept the recommendations of the Wilding report, but I also ask that we should consider the possibility of further devolution. I have extended the number of years before which it must be implemented to three to give time to assess it. It will be up to Mr. Mason, who is managing the reform, to recommend which of the main parts of the Arts Council, which are centres of excellence in the regions, would be suitable for devolution. But I would want to be reassured that they remain centres of excellence and that nothing was done to undermine that.
There will be 10 regional arts boards, and five representatives will serve on the Arts Council. I am anxious not to have a large Arts Council. For that reason I decided that membership should be limited to 20. I hope and believe that the regions will feel that they are well represented.
I am conscious of the important role that Merseyside and Lincolnshire have played in the arts over many years. There is a strength and a cultural identity in both areas. I am aware of that and I am asking the manager, Mr. Mason, to make absolutely sure that in any transitional period they do not suffer in any way and that their cultural identity is properly acknowledged.
I have decided that the tier system recommended by Mr. Wilding is not the right way to proceed because it would lead to confusion. The hon. Gentleman referred to a federal partnership. I am looking for a partnership between the Arts Council and the regional arts bodies. They will be accountable to the Arts Council and they will have to account for the expenditure of taxpayers' money, but they must work in partnership.

Several Hon. Members: rose——

Mr. Speaker: Order. Before I call Back Benchers, I remind the House that we have an important day ahead of us, with 43 new clauses and numerous other amendments to be debated. I ask hon. Members to ask single questions rather than multiple questions.

Mr. Toby Jessel: Is my right hon. Friend aware that the continued independence of the Crafts Council will be most warmly welcomed? Does he foresee increased regional control leading to more local accountability? Will the balance within each region be fairly ensured? For example, in Greater London, will there be a sanction to ensure that outer London is not treated worse than inner London from an artistic and cultural point of view?

Mr. Luce: I believe that I have taken the right decision about the Crafts Council in that it should be independent. The role of the Crafts Council in relation to craftsmen is slightly different from the role of the Arts Council in relation to artists. The Crafts Council has a hands-on role. However, I am anxious to ensure that resources are not wasted and that there is proper co-operation between regional arts and the crafts organisations.
I will summarise the regional arrangements for my hon. Friend. The basis of my announcement is that, on the one hand, there should be more devolution and responsibility in the regions, while, on the other, there should be an effective system of accountability for the use of taxpayers' money for which the Arts Council will hold ultimate responsibility to me and, through me, to Parliament. That is the basis of the system that I am advocating. Greater London Arts is responsible for the Greater London area and its job is to ensure that the arts flourish in all parts of London.

Mr. Robert Maclennan: How will the strategic role of the Arts Council be strengthened, particularly in its co-operation with the regions, if only a quarter of the members of the new Arts Council are to be drawn from the regional arts associations? Who will elect the regional arts boards? What additional funds will be made available to local authorities for their work in that area?

Mr. Luce: The local authorities already play an important role in supporting the arts. That role varies and is patchy in some areas, but it has increased over the years. Fifteen per cent. of the overall resources of the regional arts boards—as they are now to be called—presently come from local authorities. I want them to play an important role, although their members must be under the majority of the board.
With regard to the Arts Council and the appointment of five regional arts representatives, I am anxious that the members of the Arts Council should remain small in number and not more than 20. Theirs is a strategic job. They must look at the national picture—whether that is Scotland, Wales or the whole of England—and take decisions on that basis. Therefore, representatives should cover a cross-section of interests in the country, both in the arts and in the non-arts areas, and ensure that they consider things in the broadest possible sense. However, I believe the regional arts bodies will find that by having five representatives their interests are taken fully into account.

Mr. Timothy Raison: I congratulate my right hon. Friend on another excellent series of decisions. In view of the concern in Buckinghamshire about our having to belong to an extremely large Eastern Arts region, will Bucks go to the Eastern region or elsewhere?

Mr. Luce: In my letter to Mr. Palumbo I said that as Eastern Arts is taking on Lincolnshire, I did not think that Buckinghamshire should become part of Eastern Arts. Bucks is part of the East Midlands area at the moment, but I have asked Mr. Mason to consult Buckinghamshire to see whether it wants to be part of the East Midlands area or part of Southern Arts. I am grateful for my right hon. Friend's support.

Mr. Robert Sheldon: The House will have received the right hon. Gentleman's most welcome statement with pleasure. However, is he aware that if he is to achieve a diffusion of the strength of the arts in London into the regions, he will need to develop the strength of the regional boards? As my hon. Friend the Member for Stoke-on-Trent, Central (Mr. Fisher) has said, that will need money. I know that the right hon. Gentleman is providing some money, but more will be needed.
Is the right hon. Gentleman further aware that one of the great strengths of which he ought to be able to make use when approaching the Treasury is that Britain is the centre of the arts for the English-speaking world? That is an enormous strength. People come to this country not because of our weather or necessarily because of the type of people that we are, but because of the strength of the arts. If we can spread that strength through the regions, that should provide the right hon. Gentleman with a marvellous claim that he can present to the Treasury in due course.

Mr. Luce: I am grateful for the right hon. Gentleman's support for the broad thrust of the announcement. Of course, I acknowledge the important role of the arts in this country—I have said that time and again. I should have thought that the right hon. Gentleman would accept that a 24 per cent. cash increase over the next three years is a substantial commitment by the Government to the arts in this country. I hope and believe that that is the case.
I agree with the right hon. Gentleman that it is important that the regional arts boards should be robust and strong and able to manage a wide range of arts activities, from important centres of national excellence to local community arts. At the moment, they handle £30 million-worth of resources and will have a considerable further shift. That is why it is important that their boards should represent a cross-section of interests.

Mr. Malcolm Thornton: May I, too, congratulate my right hon. Friend on his decision, which will be widely welcomed in the arts world and provide a satisfactory framework for the future? However, is he aware that there will be some dismay on Merseyside about the fact that we appear to be losing our identity in the north-west? Will he assure us that the office that will be established in Merseyside will protect not only the funding that Merseyside Arts receives but the excellent innovations of and the unique place that Merseyside Arts has in this country?

Mr. Luce: I am grateful to my hon. Friend and am sensitive to the point that he has just made. Over the years,


I have paid many visits to Merseyside and have seen the arts in that area and the work of Merseyside Arts. As I said in my statement, I entirely accept that there is a clear and distinct cultural identity in the Merseyside area. If Merseyside Arts were to continue as it is, it would be too small an organisation to manage the large-scale devolution that is taking place. However, because I believe that it is so important to have strong arts on Merseyside, I have acknowledged that there should be a regional office, which will have considerable freedom, working with North-West Arts. I hope that that acknowledges my hon. Friend's important point.

Mr. Robert N. Wareing: Notwithstanding that answer, does the Minister realise that to the people of Merseyside his announcement will look like devolution in reverse? They will be concerned to ensure that the regional office is staffed as well as Merseyside Arts is staffed at present. Will the Minister assure us that there will not be any redundancies? Will Merseyside be assured of proper representation on the North West Arts board?

Mr. Luce: On the latter point, it will be exceedingly important that those organisations integrate and work closely together. I believe that there can and will be advantages to Merseyside in being part of that larger organisation while preserving its own identity through a strong regional office.
It would be wrong and misleading of me to suggest that there will not be any redundancies. At this stage, it is not possible exactly to determine the scale of staffing. There will have to be intensive discussions between Merseyside Arts and North West Arts to decide how they will work effectively together. Overall, we should not lose sight of the importance of the possible benefits to be derived from a bigger organisation.

Mr. Barry Porter: I am obliged to my right hon. Friend for making the case for Merseyside and its unique position in the arts. I have tried to follow all his arguments about administration, but I am more interested in the Liverpool Playhouse and the Everyman theatre. Perhaps my right hon. Friend will be able to help me about the representations that he has received. While the reorganisation is taking place and the balance of power shifts to Manchester, will the Liverpool Playhouse and the Everyman theatre continue to exist, or are we to have the "Terry Dicks memorial desert"?

Mr. Luce: As my hon. Friend knows so well, the arts in Merseyside are wide ranging and strong. They range from the national institutions—the national museums and galleries to which I gave national status three or four years ago—to the wide range of performing arts, the Royal Liverpool Philharmonic orchestra and the excellent theatres and playhouses. The range of arts activities on Merseyside is strong and important, and I acknowledge that. How they are funded is a matter, now and in the future, for the regional arts associations to work out in conjuction with the Arts Council. I am convinced that the important role that Merseyside plays in the arts will continue to be acknowledged.

Mr. Eric S. Heffer: Many of us believe that the right hon. Gentleman is doing as good a job as Minister for the Arts as anyone could do under the circumstances of the Government. Nevertheless, we are

disappointed at his decision not to agree that the Merseyside Arts Association should be the basis of the regional arts body. When we met him he agreed with us—and he said it again today—that Merseyside has a special and, as it were, peculiar position in the arts, based on years of great artistic activity. It has a special role to play. After a time, once the district office has been running for a while—clearly the decision will not be reversed—after, say, two or three years, will he reconsider it to see how it is functioning and whether it could be upgraded again to a regional arts body, as we on Merseyside believe that it should be?

Mr. Luce: I am grateful to the hon. Gentleman for the way in which he approaches the problem. I sought to take on board the strong views that he and his colleagues expressed to me about cultural identity. I believe that the new arrangement will not undermine the strength and importance of the arts in Merseyside. Of course, I undertake to watch developments closely. I shall ask Mr. Timothy Mason, the manager of the reforms to take into account the views that the hon. Gentleman expressed. I believe that by close co-operation between the regional office on Merseyside and North West Arts we shall find that the Merseyside area will not suffer.

Mr. Patrick Cormack: My right hon. Friend will be aware that the positive and thoughtful way in which he has responded to a constructive report has been widely welcomed. Does he accept that there will be continuing anxiety on two issues? The first is regional representation on the Arts Council. Will he take steps to ensure that there is a rotating system so that all the regions in turn are represented on the Arts Council? Secondly, does he recognise that there is still anxiety about the future of our great national companies, especially the Royal Shakespeare Company?

Mr. Luce: I am grateful to my hon. Friend for his continual support of the Government's work in the arts. I shall take his two points in turn. I have thought carefully about regional representation on the Arts Council. It is a difficult balance to strike, but the number of regional arts associations has been reduced from 12 to 10. It is reasonable to say that half of those—five—should be represented on the Arts Council. How they are selected is a matter that I am discussing with Mr. Mason, the new manager of the reforms. It will be a matter of the associations devising a system that enables them to elect either an alternative chairman or other suitable representatives, if they so choose.
I confirm that the national companies will remain firmly the responsibility of the Arts Council. That is right for them. They will receive an 11 per cent. increase in the coming financial year. Their role in this country remains exceedingly important in maintaining the highest standards of excellence.

Mr. Norman Buchan: It may be helpful if I congratulate the Minister on appointing Tim Mason from north of the border to advise on the consultative body. Obviously, I welcome the regional and devolutionary emphasis, but devolution requires a national strategy. It is not sufficient merely to devolve; there must he a national strategy. Are the boards to be development boards? Will they be a rather more hands-on body involved in the development of the arts? None of this will


be possible, not even the new structure, unless money is available. The boards may have their bones, but where is the meat? That is what is required.

Mr. Luce: On the hon. Gentleman's last point, I must reiterate that there is a propensity to ignore that there will be a 24 per cent. overall increase in the arts budget in three years. The Arts Council will get a 22 per cent. increase. In cash terms next year it will be 12·5 per cent., which is £20 million. That is a substantial increase in the Government's commitment to the arts. I attach great importance to the financial and management strength of the regional arts boards. As I say in my letter to Mr. Palumbo, it would be right for them to be incorporated. They should move in that direction because it will strengthen them in the important range of tasks that they must fulfil.

Mr. Quentin Davies: Despite the compelling logic of my right hon. Friend's proposals, does he recognise that there will be genuine anxiety? He will understand the anxiety in Lincolnshire. I am grateful for his assurance that Lincolnshire's cultural identity will continue to be respected. Will he go further and give the essential, explicit reassurance that there will be no net loss of resources to Lincolnshire as a result of the introduction of the new system?

Mr. Luce: I appreciate the anxiety that my hon. Friend has expressed. Obviously, it is important that we preserve the cultural strength of the arts throughout Lincolnshire. For that reason I said in my statement that I would ask the manager of the reforms to embark on discussions with the arts association in Lincolnshire, Eastern Arts, to work out a system that ensures that we preserve its cultural identity and strength of funding. I see no reason why Lincolnshire should in any way lose out. As part of the bigger organisation, Eastern Arts, in the long term Lincolnshire does not stand to lose; if anything, it stands to gain.

Mr. William Ross: Although the Unionist party welcomes devolution from the centre to local bodies, as it will mean that local cultural traditions will be strengthened and enhanced, we are anxious that there should be a strong fertilisation at the centre so that we do not all drift too far apart. In the light of that, why is the Minister allowing the chairman of the Northern Ireland Arts Council to attend, or not attend, the consultative body at his whim? Surely he should have to attend in the same way as the chairmen of the Scottish and Welsh arts councils?

Mr. Luce: I appreciate the hon. Gentleman's point about the need to ensure that there is a national approach and strategy on the arts. For that reason I decided that there should be a consultative body consisting of the chairmen of the Scottish and Welsh arts councils as well as the chairman of the Arts Council of Great Britain. The Arts Council of Great Britain does not fund directly the Northern Ireland arts, so I used a slightly different form of words. It is my wish and hope that the chairman of the body in Northern Ireland that looks after the arts will participate in the consultative group.

Sir David Price: On behalf of those of us who represent the arts in the south of England, may I thank my right hon. Friend for listening to our

representations and not merging South East and Southern Arts, as Richard Wilding proposed? Will he confirm that in his future model he sees the regional arts associations extending deep down into the community and working closely with the counties and all other district and borough councils in their area?

Mr. Luce: I confirm that in the 1990s I look to the regional arts boards, as they are to be called, to play an increasingly important role in strengthening the arts in co-operation with the local authorities. To achieve that, it is right to reduce the number from 12 to 10. That will provide both more scope to strengthen the boards of management and for a cross-section of people to be representatives—people from the business community, voluntary bodies and the arts—to ensure that the boards are as robust as possible to cope with what will be a great firing of and expansion in the arts as we approach the turn of the century.

Mr. Andrew Faulds: May I simply congratulate the right hon. Gentleman most warmly on this admirable new projection of policy? What an excellent Arts Minister he has become. But is he aware that some of us were proposing somewhat similar arrangements and responsibilities for the regional areas in the early 1970s and 1980s but we were, unfortunately, prevented from pursuing those matters by lack of vision of a couple of our leaders?

Mr. Luce: I shall leave it to the House to draw its own conclusions from the hon. Gentleman's remarks. I appreciate the strong support that he has given to the announcement, given his well-known and well-established interest in the arts.

Mr. Tim Devlin: Is my right hon. Friend aware that in the Northern region there will be a huge sigh of relief that Northern Arts is not to be merged with Yorkshire, although from the outset that was the most unlikely prospect among all the regional arts associations? Is he also aware that the real strength of the proposals is that there will be greater accountability for regional arts associations, there will be a much-strengthened structure for regional arts bodies and that, as a result of the Wilding report, the pressure put on Northern Arts means that a new arts strategy has been brought to Teesside?

Mr. Luce: I am grateful to my hon. Friend, who takes a keen interest in the arts. I stress that, while devolution is taking place, accountability back through the Arts Council will be more coherent and consistent than the way in which it operates at present. That will give the Arts Council a singularly important role in accounting for a national strategy for the arts and ensuring that it works in partnership with regional arts associations to benefit the arts in Britain as best it can.

Mr. Giles Radice: I congratulate the Minister on listening to our representations about Northern Arts. Can he assure the House that the new regional authorities will have new money commensurate with their new responsibilities?

Mr. Luce: I am grateful to the hon. Gentleman. The scale of the shift in resources from the Arts Council to the regional arts associations will flow from the decisions that I have taken, and it will be for Mr. Mason, the manager


implementing the reforms, to determine over the next three years, which is the time span that I have given for devolution. I expect a substantial shift in the number of clients away from the Arts Council to the regional arts associations, while the Arts Council will gain great strength for its strategic role. As far as money is concerned, I can only repeat that overall resources to the arts will increase by 24 per cent. in three years.

Mr. Neville Trotter: I congratulate my right hon. Friend on combining the new strategic role for the Arts Council nationally with an ever-increasing role for arts bodies in the regions. I add my congratulations to him for listening to the views of people in the north-east who insisted that we should retain an independent identity through the successful Northern Arts. Can he confirm that there will be no change in the boundaries of Northern Arts?

Mr. Luce: I am grateful to my hon. Friend, who has robustly made his views known to me for a number of months. I have taken his views and those of many other people seriously, and I have come to the conclusion that it would not be right to adjust the boundaries of Northern Arts, because it is a clearly identifiable area, and it should remain as such.

Ms. Joyce Quin: I welcome the fact that the Minister ruled against the proposal to merge Northern Arts and Yorkshire Arts as it was resented in both regions. In future, under the system of regional representation on the Arts Council, will the Minister bear in mind the suggestion about rotating positions on the council? Will he ensure that no region is unrepresented on the Arts Council for more than a year at a time?

Mr. Luce: I shall take into account the views that the hon. Lady has expressed about the system of rotation, which still has to be worked out. I did not want to lay down dogmatically precisely how it should operate, but I think that something can be worked out that will make sense.
I am grateful for the hon. Lady's views on Northern Arts and Yorkshire Arts. Despite my decision, I hope that there will be closer collaboration between the Northern arts board and the Yorkshire arts board.

Mr. Tim Rathbone: Does the Minister accept that, from the point of view of my constituency and the south-east, everything that he has said and the reassurances that he has given mark him as the Minister who has made the most positive announcement in the House at any time since the Conservative party returned to power?

Mr. Luce: As it comes from my hon. Friend, I take that as a very nice compliment.

Mr. David Clelland: The Minister's statement will be widely welcomed by people in the Northern region, with the possible exception of his hon. Friend the Member for Stockton, South (Mr. Devlin), whose conversion we also welcome, since originally he was in favour of a mega-region for the north. Does the Minister acknowledge the contribution made to the arts by local authorities in the area? I refer in particular to the metropolitan borough of Gateshead, with its policy of providing art in public places, and the city of Newcastle, which boasts some of the finest theatres in the country.

However, will the Minister consider specifically the present per capita basis for the distribution of Arts Council grants, which seems to me to work against regions such as the north?

Mr. Luce: I have paid a number of visits to the Newcastle area and to Northern Arts. I very much appreciate the work that is going on there. The collaboration between Northern Arts and the local authorities is strong and effective and produces excellent results for the arts. I am grateful to local authorities for the role that they play. Support for the arts throughout the country does not require vast sums of local authority money; often it requires only modest sums. Through collaboration with the regional arts associations we can see what benefits that brings.
Per capita support for the arts in the Northern region is a matter for the Arts Council. It has to decide how to distribute the money, taking into account the overall support per capita for the population of the area, as opposed to the rest of the country, and other factors, including the strength of the arts in the area.

Mr. Richard Alexander: I join hon. Members in welcoming my right hon. Friend's statement, but I ask him to look yet again at regional representation. Does he not realise that those authorities that have no Arts Council representation will resent the fact that no one is batting for them? Would it not be possible to avoid that resentment by providing five additional seats? It would avoid rotation, elections and the sort of thing that my right hon. Friend has described.

Mr. Luce: I appreciate my hon. Friend's point. However, there is already a system under which, by means of a kind of electoral college, there are three representatives from the regions—one from the northern area, one from the midlands and one from the south. That has been operating fairly effectively and fairly well for two or three years. I am expanding that mechanism to ensure that instead of three representatives there are five. It will be possible to work out a sensible formula. I want the size of the Arts Council to remain modest. Such bodies can become too large and cumbersome. In this way I believe that we shall ensure that the regions are well represented. However, I shall think about my hon. Friend's point.

Mr. Gerry Steinberg: I genuinely welcome the proposals, unlike some hon. Members who seem to have changed their minds. I congratulate the Minister on taking notice of the representations regarding Northern Arts and the courtesy that he extended to us when we met him. It must be the first time that a Minister has taken notice of representations.
I welcome the decentralisation of arts and local government involvement. The Minister referred to resources. I urge him to keep a constant eye on resources, in particular for Northern Arts so that it does not find that it is without the funds that are necessary to make a success of decentralisation.

Mr. Luce: Yes, of course—to the extent that there is a considerable measure of devolution. The amount of money that follows devolution will have to be discussed by the Arts Council, the regional arts associations and Mr. Mason, who will be implementing the changes. Those factors will be taken seriously into account.

Mr. John Bowis: May I add to the beatification of my right hon. Friend by welcoming warmly his announcement, particularly in relation to the Crafts Council and also devolution?
May I ask him to work with Mr. Mason, when dealing with the new opportunities in regional arts at local level, to ensure that the environment being created, as well as being good for artists, provides new opportunities for people to participate? On the question of ethos, will he ensure that there is an open-door policy so that more people may enjoy and benefit from the arts?

Mr. Luce: My hon. Friend is right. In this context, I reaffirm the objectives of the royal charter of the Arts Council and, in turn, the objectives of the regional arts boards: to promote interest in the arts in this country, to improve access, and to ensure the highest possible quality. We are referring to all levels of activity in the arts—from the community level, right up to the national centres of excellence. This is an important opportunity to reaffirm that, as we look to the 1990s and to greater public interest in the arts, there will be a very important and significant role for the regional arts boards.

Several Hon. Members: rose——

Mr. Speaker: Order. I draw attention again to the pressure of business. I know that today's business is exempted, but if hon. Members wishing to ask questions will be brief, I hope to call all of them.

Mr. Tony Banks: I will award the Minister five out of 10 for the structural changes. However, I repeat the question: where is the beef to back up the structural change? The Minister has talked about 24 per cent. over three years. Of course, to gauge its usefulness, that will have to be set against inflation and the effect of the poll tax. Is the Minister aware that virtually every local authority in London is setting a budget that involves cuts in expenditure on arts and leisure activities? What monitoring is being done to ensure that the Greater London arts association, which will have the greatest concentration of clients, will not inherit a major arts crisis?

Mr. Luce: I cannot be precise about the budget of the Greater London arts association, but I think that it is about £9 million. The association gets a larger share, in absolute terms, than any other regional arts body.
In answer to the hon. Gentleman's point about the resources that are available, I would point out that two factors have to be taken into account. One is the overall budget for the arts—I have mentioned the figure several times—and the other is the shift of resources that will go with devolution. The latter must be a matter for discussion and negotiation between the Arts Council, the regional arts boards and Mr. Mason, who is implementing these plans. In the absence of agreement on what sums of money should be transferred from the Arts Council to the regional arts boards, it would not be right to take decisions about devolution to these bodies.

Mr. Brian Sedgemore: While welcoming the devolution proposals, may I ask whether the Minister's statement means that the main philosophical and artistic thrust of the proposals contained in the "Glory of the Garden" and the Cork report have been entirely abandoned? In that regard, will

more money be available to the Royal Shakespeare Company to enable it to keep its doors open at the Barbican in November?

Mr. Luce: I do not think that this undermines the "Glory of the Garden" policy of the middle 1980s. The purpose of that policy was to set up regional centres of excellence to attract interest. I take as an example the Plymouth area, where the Royal theatre has created a great deal of interest and has attracted support from Cornwall and Devon for the setting up of regional centres. That is important. In my view, not all centres of excellence should be in London. Although this city must remain a great cultural centre, we should have centres of excellence throughout the country. Glasgow—the cultural city of 1990—is an example. National bodies such as the Royal Shakespeare Company will remain the responsibility of the Arts Council, which must make the final judgment. The success of the Royal Shakespeare Company is there to be seen. The company has taken some difficult management decisions. There has been quite a lot of debate in the House on this matter, and I know that the Arts Council attaches great importance to the company's work.

Mr. Chris Smith: The Minister will be aware that the Sadler's Wells theatre, which is known nationally and respected internationally, currently faces severe financial difficulties. He will know also that, by indirect arrangement, it receives funding from the Arts Council. It is possible that, under the new arrangements, that funding will be endangered. Can the Minister give me an assurance that he will do everything he can to ensure that Sadler's Wells not only survives but thrives?

Mr. Luce: I will draw to the attention of the Arts Council chairman the views that the hon. Gentleman has just expressed about Sadler's Wells, which has played a long and important role in arts in London. I realise that a number of changes are taking place. For instance, Sadler's Wells Royal ballet is moving to Birmingham. That is not necessarily a bad thing for the arts as a whole, as Birmingham, too, is a great and increasingly important centre of excellence.

Mr. Martin Flannery: As a member of the Select Committee on Education, Science and Arts, I have questioned the Minister many times, and I have always thought that he shows a civilised approach to the arts. The right hon. Gentleman is trying to instil in us his confidence about money, and I hope that it is justified. As he knows, I come from Sheffield, in South Yorkshire. The rejuvenated Lyceum theatre, of which I am a director, will open, I hope, in December. It is the only theatre in Britain outside London designed by the architect responsible for it. The region is an arts area. I should like to know whether the people who join the Arts Council from the regions will be elected or picked and how the regional boards will be instituted.

Mr. Luce: I warmly welcome the role that the hon. Gentleman plays in the arts in Yorkshire. He will have noted that the new playhouse for Yorkshire opened in Leeds last week. It will have an important role for the arts in that area.
I am giving some thought to how the representatives from the regions will be chosen. I think that the mechanism will provide for twinning of the 10 regional


associations into five pairs, which between them will select a representative for their area for a defined period. The representative posts will rotate and, after another period, the associations will have to choose another representative. That representative may be the chairman of the regional arts association or someone else who is considered equally appropriate.

Mr. Tam Dalyell: On Timothy Mason, is not Scotland's loss his gain? What policy funding conclusions are raised by the case of my constituent, Lizzie, the 340 million-year-old early carboniferous reptile found near Bathgate? Is the right hon. Gentleman aware that the Geologists Association has contributed £10,050 from its fund, easily the largest contribution it has ever made? By what mechanism will the Government help funding for geological specimens in this position and stop their export?

Mr. Luce: The Scottish Arts Council has done an outstanding job for many years. It has been under Mr. Mason's leadership as director for many years. There are many centres of excellence in Glasgow, Edinburgh and many other parts of Scotland.
As for Lizzie the lizard, which I think is the best way to encapsulate her title, I have asked the Reviewing Committee on the Export of Works of Art to look at this case and to recommend whether such objects should in future be included under the control system.

Mr. Frank Haynes: The Minister gets no congratulations from me today. In his statement, he has failed in his ministerial duty to the arts generally. He has tried to cool the pressure from the regions by giving them this and that and giving them a committee on which to serve, but no additional money is made available. When he made his previous statement we argued with him about additional money. The amount available does not keep pace with inflation. We shall have to keep the services going and improve them. The Minister can stop making statements such as he has made today. That is why I say that I do not congratulate him. He has not done his job properly.

Mr. Luce: There is nothing new in that; the hon. Gentleman has not yet congratulated me on anything, but I do not resent that.
I think that the hon. Gentleman is a little confused. He does not seem quite to have grasped the fact that I am shifting more strength and resources to the regional arts associations. I should have thought that he would welcome that news for his area rather than despise it. I should have thought that he would welcome the fact that we are increasing resources for the arts overall by 24 per cent. in the next three years. Instead of despising that news, the hon. Gentleman should encourage the flourishing of the arts which we will see in the 1990s, thanks to the Government's commitment.

Mr. Fisher: Apart from my hon. Friend the Member for High Drama and Great Acting—my hon. Friend the Member for Ashfield (Mr. Haynes)—the Minister has received and earned the praise and congratulations of the whole House on almost all he has said today——

Mr. Dennis Skinner: No.

Mr. Fisher: He has received congratulations on almost everything he has said today. As my hon. Friend the Member for Sheffield, Hillsborough (Mr. Flannery) asked, how will the regional boards be elected—that is, the regional boards themselves rather than the representatives on the Arts Council? Will the Minister give some thought to the effect of the shift of resources to the regions? The regions with many Arts Council clients will benefit disproportionately. There will be a need to address the imbalances that arise from that. The Minister will be congratulated generally by the arts world on his statement. He has set up a structure today on which the next Labour Government will be keen to build in the 1990s.

Mr. Luce: The hon. Gentleman has been generous in his remarks, and I am grateful for that. I shall give fair and serious thought to his points about the amount of money against the background of the shift in responsibility for various clients to the regional arts association.
Each regional arts board will elect its own chairman, who must ensure that the board—which must not have more than 24 members—will represent the range of interests in the arts, whether arts people, local authority representatives, business men or people from voluntary bodies. I want the range to be as broad as possible so that the boards can do an effective job for the regions.

Points of Order

Mr. Ken Maginnis: On a point of order, Mr. Speaker. In the light of the decision today by the Irish Supreme Court to reject this Government's application for the extradition to Northern Ireland of the Maze escapers, Finucane and Clarke, and as we must deduce that the real reason stems from the Irish Republic's legal claim to jurisdiction over Northern Ireland, as confirmed in the McGimpsey judgment a few days ago, the logical consequence of which is that the Irish Republic could not extradite to territory that it now deems to be its own, has the Attorney-General said to you, Mr. Speaker, that he intends to make an early statement to the House on this serious matter?

Mr. Speaker: The Attorney-General has not made such an application to me, but I note that the hon. Gentleman has the Adjournment debate tomorrow night. I am certain that, especially if he were to let the Minister know as a matter of courtesy that he proposed to raise this matter, he would receive an answer.

Mr. Tim Devlin: On a point of order, Mr. Speaker. In the light of today's pronouncement by Congressman Kennedy of the United States legislature that Irishmen are unlikely to receive a fair trial in this country, will there be an opportunity for us to debate whether Cubans, Mexicans or black people receive a fair trial in the United States?

Mr. Speaker: That is not among my many responsibilities. I am sure that, with a certain amount of ingenuity, the hon. Gentleman will be able to raise the matter in order, perhaps in an Adjournment debate.

Mr. Dennis Skinner: On a point of order, Mr. Speaker. It will not have escaped the notice of all hon. Members and perhaps people outside the House that today we had 55 minutes on an undoubtedly important statement, according to those who made contributions. However, it is certain that it was not very controversial. I hope that if there is another controversial item, such as the House of Fraser report, you might consider, Mr. Speaker, that half an hour is not sufficient for a matter concerning fraud in the City.

Mr. Speaker: The hon. Gentleman has raised this matter before. I do not give reasons for my decisions on these matters. However, I want to point out again to the hon. Gentleman and to any others who are interested that I have to take into account the pressure on business later in the day. When we had the statement on the Harrods affair, there was an important debate which had to end at 10 pm and in which many hon. Members wanted to participate. Many of them have subsequently written to me regretting that they were not called. Today we have exempted business, which can go on until any hour. I therefore allowed the statement today to range, which seemed reasonable in view of the time available later.

BILL PRESENTED

HARE COURSING (ABOLITION)

Mr. Harry Cohen, supported by Mr. Robin Corbett, Mr. Gerald Bermingham, Mr. Tony Banks, Mr. Jeremy Corbyn, Mr. Eric S. Heller, Mr. Doug Hoyle, Mr. Gerry Steinberg and Mr. David Hinchliffe, presented a Bill to make hare coursing illegal: And the same was read the First time; and ordered to be read a Second time on Friday 30 March and to be printed. [Bill 97.]

Political Parties (Income and Expenditure) Bill

Mr. David Winnick: I beg to move,
That leave be given to bring in a Bill to provide for a limit on the amount of money which may be spent by or on behalf of a political party during the period of a general election campaign; to require companies to establish a political fund from which all political donations shall be made; to provide for a ballot of shareholders and employees before a political fund is established; to ensure an entitlement for each shareholder to an additional dividend from the company in lieu of any donations to which such a shareholder has objected; and to require political parties represented in the House of Commons to publish reports and accounts.
I am proposing in my Bill some limited measures, including a limit on the amount of money that a political party can spend nationally during a general election campaign. That must make sense when there has been, rightly, a tight restriction on what may be spent in a constituency on behalf of a candidate. We are all aware of what happens—[Interruption.] Perhaps I may have the attention of the hon. Member for Birmingham, Selly Oak (Mr. Beaumont-Dark)——

Mr. Speaker: Order. It would be helpful if the chat across the Chamber, between the Front Benches below the Gangway, ceased. Let us listen to what the hon. Member for Walsall, North (Mr. Winnick) has to say.

Mr. Winnick: We know what happens if there is an overspend. The candidate and agent involved can be made to appear before the High Court and, in such circumstances, a successful candidate can be disqualified. On the national scene, a party can spend without limit and thus undermine the established concept applying to candidates. The rule applying to candidates was brought in to ensure some equality between those standing for election to this House. In other words, the fact that one has considerable money should not entitle one to spend as much as one likes on the local scene.
The situation is, however, different nationally. At the last general election my party spent some £4 million. The Tories spent £14 million during the three weeks of campaigning, and they had much more cash available had they been in doubt about the outcome of the election.
If my proposals are accepted, an initial sum could be agreed and it could be updated from time to time. That applies now to the expenditure of candidates; the Home Secretary proposes in an Order in Council that the sum be increased. As a starting sum, I would suggest £4 million nationally for a general election campaign. If my Bill gets a Second Reading, I would be willing to listen to all the arguments in Committee and, being a charitable person, would be willing to increase that figure if an adequate case for doing so were made out.
I am also anxious to make changes in the method by which political donations are made by companies. I want to establish equity between trade unions and companies. For nearly 80 years, from 1913, unions had to establish by ballot a political fund before any donations of a political nature could be made. In recent times the Conservatives have, as we know, legislated to the effect that such ballots must take place every 10 years. Ballots were held and all trade unions with political funds re-established the right to

have them, and a few unions that did not previously have funds held ballots, won the day and established political funds.
The situation with companies is totally different. The board of a company may simply decide to make a political donation. There is no ballot, no political fund and not even consultation with shareholders and employees. It is a mockery to insist that trade unions must be tightly controlled over political funds whereas companies can make donations in that way.
It may be argued that at annual general meetings of companies shareholders can protest about what is being done, but a former Law Lord said:
It sometimes happen that public companies are conducted in a way which is beyond the control of the ordinary shareholders. The majority of the shares are in the hands of two or three individuals. These have control of the company's affairs. The other shareholders know little and are told little. They receive the glossy annual report. Most of them throw them in the wastepaper basket. There is an annual general meeting, but few of the shareholders attend. The whole management and control is in the hands of the directors.
That was said, in the giving of a legal judgment, by Lord Denning, who cannot be accused of any pro-Labour bias.
The way in which companies conduct their affairs reminds one of the way in which the Conservative party organises its internal affairs. I suggest that companies must hold a ballot of shareholders, plus employees who have been with the company for longer than 12 months. Let them decide whether a political fund should be established If it was, provision would have to be made for those opting out—as anyone in a trade union can, rightly, opt out from political donations if he wishes.
We are talking not about peanuts—£200 or £400—but about rather larger sums. In 1988 alone Taylor Woodrow donated £111,000, P and O Steamship Company £100,000, Allied Lyons £95,000, United Biscuits £85,000, Hanson Trust £80,000, Whitbread £76,000, Consolidated Gold Fields £75,000, Trusthouse Forte £61,000, Hambros £61,000, British Airways—once privatised—£50,000, General Electric Company £50,000 and Trafalgar House £40,000.[Interruption.] A number of my hon. Friends are asking me about certain brothers. I have looked through the list, and I concede that I cannot find the House of Fraser, but who knows what may happen next year? They may make a handsome contribution to the Conservative party.
It is not only companies that donate the money that I have mentioned. Tory front organisations—the British United Industrialists, the Industrialist Council, Aims for Industry and the Economic League, which carries out a policy of victimisation against active trade unionists—all receive large sums from companies where no ballot on political donations has taken place. That is totally wrong and unfair.
I believe—and it is contained in my Bill—that all parties represented in the House should publish full accounts of their finances. My party has always done that. However, that is not the case with the Conservative party. Labour Members are not the only people who say that. I had never heard of the river companies until the story appeared in a national newspaper. They are organisations that were set up after the war to secrete funds from companies to the Tory party. Peter Hardy is a prominent dissident and a member of the Charter movement [HON. MEMBERS: "Who?"] If Conservative Members have not


heard of him they may have heard of Eric Chalker. They are both campaigning for greater openness and democracy in the Tory party. Peter Hardy—who is no less a Conservative than are Tory Members—said:
we have long suspected the party has hidden reserves in secret bank accounts … The almost obsessive secrecy of the party organisation combined with the total lack of accountability of the party treasurers makes the Tory Party a soft target for its opponents.
When I last spoke on that subject I said that I was not sure whether the Conservative party or the Communist party in the Soviet Union was less democratic. That was four or five years ago. Given the changes on the Soviet scene, I think that the Soviet Communist party is at long last beginning to become a little more democratic. As we near the end of the 20th century it is about time that the Conservative party became fully democratic, published its accounts and made itself accountable in the way that all political parties should

Question put and agreed to.

Bill ordered to be brought in by Mr. David Winnick, Mr. Tony Banks, Mr. Terry Davis, Mr. Don Dixon, Mr. Harry Ewing, Mr. Derek Fatchett, Mrs. Maria Fyfe, Mr. James Lamond, Mr. Rhodri Morgan and Ms. Marjorie Mowlam.

POLITICAL PARTIES (INCOME AND EXPENDITURE)

Mr. David Winnick accordingly presented a Bill to provide for a limit on the amount of money which may be spent by or on behalf of a political party during the period of a general election campaign; to require companies to establish a political fund from which all political donations shall be made; to provide for a ballot of shareholders and employees before a political fund is established; to ensure an entitlement for each shareholder to an additional dividend from the company in lieu of any donations to which such a shareholder has objected; and to require political parties represented in the House of Commons to publish reports and accounts: And the same was read the First time; and ordered to be read a Second time upon Friday 20 April and to be printed. [Bill 98.]

Points of Order

Mr. D. N. Campbell-Savours: On a point of order, Mr. Speaker. The House is about to consider the important National Health Service and Community Care Bill. It is enabling legislation in so far as it provides district health authorities with the right to let contracts and extends the principle of privatisation that has been introduced in recent years.
One aspect of the Bill that is causing concern to millions of people is how the public can be assured that Members of Parliament with a pecuniary interest in the privatisation of contracts will not vote in the Divisions that will take place during the next two and a half days.
In 1982, when the Lloyd's Bill was considered by the House, Mr. Speaker Thomas allowed a number of points of order on the rights of Members of Parliament to vote on that private Bill. This is a public Bill, affecting 52 million people in Britain. There will be votes and we are dealing with privatisation contractorisation. As you know, Mr. Speaker, we are required——

Mr. Speaker: I think that I have the drift of the hon. Gentleman's point of order.

Mr. Campbell-Savours: There are two kinds of interest. First, there is sponsorship by trade unions whereby Members personally receive nothing from the unions but where money is paid to constituency parties to run surgeries to help people in need of advice, in the same way that citizens' advice services are run. Secondly, there is a payment made direct to Members which they can use for their own private purposes and which derives from their being a consultant or a director of a lobbying company or a company directly involved in private health care. These are important matters for the general public.

Mr. Speaker: Order. The hon. Gentleman never uses one word when 10 will do. Will he kindly come to the point, please?

Mr. Campbell-Savours: I am explaining this because the public have been grossly misled about what constitutes pecuniary interest.

Mr. Speaker: Order. I can answer the hon. Gentleman without hearing any more. This is a matter of public policy, and the hon. Gentleman well knows the rules because he is a member of the Select Committee on Procedure. He knows that any hon. Member who participates in a debate and who has an interest should declare it, whether he is a trade union member or has any other interest. But on matters of public policy it has always been the practice for hon. Members to cast their vote.

Mr. Campbell-Savours: That is not my point of order.

Mr. Speaker: Well, what has the hon. Gentleman been saying to me for the past 20 minutes?

Mr. Campbell-Savours: I put it to you, Mr. Speaker, that, of the 52 million people out there, 30 million understand exactly what we are doing in the House tonight. They demand that Members of Parliament who receive money directly from private health care should not be allowed to vote in our Divisions tonight and tomorrow, and they look to you, Mr. Speaker, to ensure that.

Mr. Speaker: Order. I must interpret the rules. I have already stated what they are, and that is what will happen today. If the hon. Gentleman wants the rules changed, that must be done in a different way. At the moment I am bound by the rules.

Mr. Max Madden: Further to that point of order, Mr. Speaker. Between 20 and 30 Conservative Members are directors or shareholders of or advisers to companies which will undoubtedly supply goods to the trusts that the Bill establishes. During the next few days we shall be debating legislation which seeks to make fundamental changes in the structure and organisation of the NHS. It suggests the formation of self-governing trusts. Therefore, I ask you to reflect upon the unique situation created by the Bill whereby those hon. Members could be held to have a direct pecuniary interest in the public policy that is being debated in the legislation.

Mr. Speaker: Order. We debated the matter at some length last week when the hon. Member for Bolsover (Mr. Skinner) drew my attention to the fact that I had limited the time allowed on a statement so that it could be fully debated. The House will have to decide on any change that there may be to the rules, but at the moment I repeat that any direct interests should be declared by hon. Members on both sides of the House, but hon. Members may vote on any matters of public policy. Let us get on with the Bill.

Orders of the Day — National Health Service and Community Care Bill

As amended ( in the Standing Committee), considered.

[The following Reports and Minutes of Evidence of the Social Services Committee are relevant: Eighth Report, Session 1988–89, resourcing the National Health Service: the Government's plans for the future of the NHS (House of Commons Paper No. 214-III); Second Report, Session 1989–90, Community Care: Future funding of Private and Voluntary Residential Care (House of Commons Paper No. 257); Third Report, Session 1989–90, Community Care: Funding for local authorities (House of Commons Paper No. 277); Minutes of Evidence taken on 17th, 24th and 31st January 1990 (House of Commons Papers Nos. 148-i, 173-i and 194-i); and the Government's Reply to the Eighth Report of Session 1988–89 (Cm. 851).]

Mr. Dennis Skinner: On a point of order, Mr. Speaker.

Mr. Speaker: I shall take a point of order on the new clause that we are about to debate.

Mr. Skinner: You referred, Mr. Speaker, to the debate that lasted almost six hours on the hon. Member for Winchester (Mr. Browne). The public had a good view of it because it was on television, certainly on some channels. As a result, people heard an hon. Member saying, "I'm awfully sorry that I didn't put this firm and this money in the register."
My hon. Friend the Member for Workington (Mr. Campbell-Savours) raised a point of order on the Bill that we are about to debate. The people who are watching television will think that it is a bit strange that we are debating the shifting of money from the public to the private sector, lining the pockets of trusts and the Tory Members who are involved in those trusts, yet this quaint little cock-eyed place, the House of Commons, will do nothing about it. They will find that odd.

Mr. Speaker: Order. We had a full debate on the matter last week. I do not know whether the hon. Gentleman was not called due to the shortage of time.

Mr. Skinner: No, I did not put my name down. I tried to catch your eye, Mr. Speaker.

Mr. Speaker: Perhaps the hon. Gentleman should have sought to be called in order to make those points. However, I repeat that the House knows that Mr. Speaker has to interpret the rules as they are.

Mr. Edward Leigh: Further to that point of order, Mr. Speaker. Is it not ironic that the hon. Member for Workington (Mr. Campbell-Savours), who is about as easy on the ear and as original as a neeedle stuck in a gramophone record, is the one member of the Standing Committee which considered the Bill whose election expenses are paid for by a Health Service union?

Mr. Speaker: If they are, no doubt the hon. Member for Workington (Mr. Campbell-Savours) will declare that.

Mr. D. N. Campbell-Savours: On a point of order, Mr. Speaker.

Mr. Speaker: Order. We must get on.

Resolved,
That the National Health Service and Community Care Bill, as amended, be considered in the following order, namely, new Clauses, Amendments to Clauses 1and 2, Schedule 1, Clause 26, Schedule 5, Clauses 3, 4, 28 and 5, Schedule 2, Clauses 6 to 11, Schedule 3, Clauses 29 to 31, Schedule 6, Clauses 12, 35, 13 to 17, 32, 18, 33, 19 and 20, Schedule 4, Clauses 34, 21, 36, 22, 37, 23, 38, 24, 25, 27, 39, 52, 40, 53, 41 to 43, 48, 44, 51, 45, 49, 46, 47, 50 and 54 to 56, Schedule 7, Clauses 57 to 61, Schedule 8, new Schedules, and Amendments to Schedule 9 and Clause 62.—[Mr. Kenneth Clarke.]

Mr. Campbell-Savours: On a point of order, Mr. Speaker. Will you confirm that I, like every Labour Member of Parliament who might be sponsored, receive nothing personally from a union either as income or expenses? Despite the fact that the rules state clearly that hon. Members can vote on these matters, you have a discretion, in the light of public concern, to advise hon. Members not to vote in the Divisions that will take place during the next two and a half days, so will you please do so?

Mr. Speaker: Order. I cannot answer the hon. Gentleman's first question. I have no idea what remuneration he may receive as a result of being sponsored by a union.

Mr. Campbell-Savours: Nothing.

Mr. Speaker: Order. I draw the hon. Gentleman's attention to what the hon. Member for Copeland (Dr. Cunningham) said last week in relation to sponsorship by a union.

Mr. Campbell-Savours: rose——

Mr. Speaker: Order. I am not having any more.

Mr. Campbell-Savours: You, Mr. Speaker, have just ruled——

Mr. Speaker: Order. I have not ruled. I am saying that I do not know.

Mr. Campbell-Savours: The Register of Members' Interests shows the position. May I ask you, Mr. Speaker, to withdraw your statement that you have no idea?

Mr. Speaker: I take the hon. Gentleman's word for it.I have no responsibility for the personal declarations that are made in the register. That is not a matter for me. The hon. Gentleman has declared his interest.

Mr. Campbell-Savours: You are compounding the confusion, Mr. Speaker.

Mr. Speaker: Order. Will the hon. Gentleman please sit down so that we can get on with the debate?

New clause 74

SPECIAL HEALTH BOARDS

'In section 2 (Health Boards) of the 1978 Act—

(a) in subsection (1)—


(i) after the words "Secretary of State" there shall be inserted the word "(a)"; and
(ii) after the words "Health Boards" there shall be inserted—

"and

(b) Subject to subsections (1A) and (1C), may by order constitute boards, either for the whole of Scotland or for such parts of Scotland as he may so determine, for the purpose of exercising such of his functions under this Act as he may so determine; and those boards shall, without prejudice to subsection (1B), be called Special Health Boards.";

(b) after subsection (1) there shall be inserted the following subsections—

"(1A) An order made under subsection (1)(b) may determine an area for a Special Health Board constituted under that subsection which is the same as the areas determined—

(a) for any other Special Health Board; or
(b) for any Health Board or Health Boards constituted by an order or orders made under subsection (1)(a).

(1B) An order under subsection (1)(b) may specify the name by which a board constituted by the order shall be known.

(1C) The Secretary of State may by order provide that such of the provisions of this Act, or of any orders, regulations, schemes or directions made under or by virtue of this Act, as apply in relation to Health Boards shall, subject to such modifications and limitations as may be specified in the order, so apply in relation to any Special Health Board so specified."; and

(c) in subsection (2), for the word "(1)" there shall be substituted the word "(1)(a)".'.—[Mr. Michael Forsyth.]

Brought up, and read the First time.

The Parliamentary Under-Secretary of State for Scotland (Mr. Michael Forsyth): I beg to move, That the clause be read a Second time.

Mr. Speaker: With this it will be convenient to take Government amendments Nos. 266 to 268.

Mr. Forsyth: The new clause and the amendments are important as they allow the Secretary of State for Scotland to set up a special health board in Scotland. Those powers do not exist in Scotland, and I should explain to the House why my right hon. and learned Friend the Secretary of State would like to have them. This arises out of the review that we have undertaken of health education in Scotland—a review carried out on the Secretary of State's behalf by Touche Ross—and a report that has been produced on the incidence of coronary heart disease in Scotland.
Although in Scotland we spend about 25 per cent. more per head on health than is spent in England, we still have very high levels of coronary heart disease and lung cancer, and life expectancy is still lower in Scotland than it is south of the border. The Government have made health education and the promotion of good health part of their priorities for the Health Service in Scotland. Following the reports that have been made to the Government, it has become apparent that there is a need for a body in Scotland with the status and standing to ensure that our health promotion policies are given the centre-stage position that is required.
At present, health education is the responsibility of the Scottish Health Education Group, which is part of the Common Services Agency. The Secretary of State would


very much like to create a new body that would be a special health board with responsibilities for health education and promotion throughout Scotland. That body would have as its purpose the implementation of a policy statement of priorities in health education and would be responsible for achieving the targets set by central Government. It would work closely with health boards.
It is for those reasons that we are proposing the new clause and the amendments. It is our intention to establish the new body and to have it set up and working by 1 April 1991. It is essential that we move with speed. The Public Accounts Committee has drawn attention to the need to focus our health education programmes more effectively, and I accept the advice given and the criticism made in the past. Having said that, I believe that we have made great progress in health education. I make no criticism of those who have worked so hard to achieve that in the past.
I hope that the new clause and amendments will be welcomed on both sides of the House. This is a positive step forward. It is an attempt to meet the SHARPEN priorities, which we set out more than a year ago, in which health promotion and education were given a centre-stage position. I have considerable pleasure in commending the new clause and amendments to the House.

Mr. John Maxton: rose——

Mr. Barry Porter: Declare your interest.

Mr. Maxton: The hon. Member for Wirral, South (Mr. Porter) has asked me to declare my interest. I can tell the House that I am a member of the Management, Science and Finance union, but I receive no sponsorship for elections from that union and am not a sponsored member of it. I am not sponsored by any union except very indirectly, I suppose one might say, through the new clause, as the money for my expenses comes from the Labour club, and drinking and smoking provide a lot of its income. But that is another matter.
I think that everybody must welcome this new clause, but the problem that we have with it is that it makes no reference to health education. It is a broad, general clause dealing with special health boards in Scotland. It gives the Secretary of State powers considerably wider than those of health education. Opposition Members are suspicious that it is being done in this way, especially as the new clause was put down on Friday, which meant that the Opposition had no opportunity to table amendments to make it specific to health education. That arouses our suspicions about the Minister's intentions.
The Minister's problem in Scotland is that no one trusts him. He may have the best intentions in the world about this legislation and the new clause, but the people of Scotland, particularly when he takes such wide powers, simply do not believe him. They always look for ulterior motives and other things for which he intends to use such powers.
Increasingly, people in Scotland distrust not only the Minister's intentions, but his competence. One can only assume, as the Prime Minister stayed at the hon. Member's house for the night that she was in Scotland, that he was the person who advised her on her whole trip to Scotland. If he can create that sort of public relations disaster, we have every right to distrust his competence in anything at all, particularly since the Prime Minister went to Ibrox to make the draw for the Scottish Cup. If hon. Members

wonder why this is relevant, I will tell them exactly why. Until last year the Scottish Health Education Group sponsored the Scottish Cup; therefore the Prime Minister and the Minister had a direct interest at that time, although they have not now. To advise the Prime Minister to go to Ibrox in connection with the draw for a cup in which Rangers Football Club is no longer involved really takes a bit of beating and could cause considerable distress to many football supporters in Scotland. Her performance on television was appalling. That she should describe herself as a Scot by saying "we in Scotland" all the time takes a bit of believing.

Mr. Bill Walker: The hon. Gentleman, with his interesting ancestry, is trying to lay claim to a Scottish background and history. He should remember that some of us are real Scots.

Mr. Maxton: I do not know whether the hon. Member can make the claim that I can, that both his mother and his father were born in the constituency that he now represents. If that does not make me a Scot, I do not know what does.
The Minister's intentions and competence in this matter make us a bit suspicious and I think that we ought to ask him to explain why he is taking broad powers instead of specific powers. Why did not he simply table a clause to set up a new body in Scotland to deal with health education? What else will he use these powers for? The House is entitled to answers to those questions.
I still do not understand, even from what the Minister said, what exactly will be different in health education compared with what was done by the Scottish Health Education Group, for which I have a very high regard. I criticised it in an article that I wrote in The Runner magazine in Scotland because it did not sponsor enough running but sponsored football. However, a lot of its work in health education led the field not just in Scotland but in Britain, and in some cases in Europe; it was very advanced.

Mr. Walker: I did not have the opportunity to read that article, but I am sure that it was interesting, because I have enjoyed reading other things that the hon. Gentleman has written. Does the hon. Gentleman believe that, when one writes articles and is paid for them, one should make a declaration in speeches in the Chamber, particularly if an article has been on Health Service matters?

Mr. Charles Kennedy: No, definitely not.

Mr. Maxton: The hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) may have an interest to declare. For myself, if the hon. Member for Tayside, North (M r. Walker) knew anything about The Runner magazine in Scotland, he would know that it runs on a shoestring and does not pay contributors anything, so I did not get paid for the article.

Mr. Kennedy: The hon. Gentleman should bear in mind that that may be the story he was told when the magazine got his copy.

5 pm

Mr. Maxton: That is always possible. However, I know the people who run the magazine and I think it fair to say that they do not have any money. That is taking us rather wide of the new clause.
The Scottish Health Education Group has done good work in Scotland. In his brief speech, the Minister did not give us reasons why the group should disappear and a new body should be established. We need to know more about the relationship between a new health board and the other health boards in Scotland in regard to health promotion.
I shall give one example from my area—the "Good Hearted Glasgow" campaign run by the Greater Glasgow health board. I do not know how effective it is, but it has done well in publicity. Whether it has stopped large numbers of people smoking or eating foods with high cholesterol is another matter. In that respect there is a question mark over health education. Certainly we need to know whether such a campaign would be taken over by the new health board or would remain with the Greater Glasgow health board. If it is taken over by the new health board, where is the division in responsibility? The "Good Hearted Glasgow" campaign is not just about advertising and education; it is also about the provision of screening of blood pressure and so on, particularly of men of a certain age. Will the Greater Glasgow health board continue to do that while the new board takes over publicity? I hope that the Minister will give us more information on that.
When I first read the new clause, before the Minister kindly told me exactly what he intended, I wondered whether it had a relationship to the new Health Service executive which the Minister suddenly announced last week. Does he intend giving the new executive legislative standing by creating a special health board which would have power over all the other health boards in Scotland? That suspicion still remains. The Minister may set up such a body, but I am not sure that it would have great legislative standing under this legislation or under the National Health Service (Scotland) Act 1978. Does the Minister intend to use the new clause later to give that body powers?
The clause is broad enough to allow the Minister to explain to the House exactly who he intends to appoint to the new executive body, how much each will be paid for being a member, what contracts they will have, and the terms of the contract. We have grave suspicions about the body, as we have about Mr. Cruickshank, the chief executive of the Health Service in Scotland. We do not believe that the Health Service can be run as a private business like Virgin Records. It should be run for the benefit of the health of patients in Scotland.
I hope that the Minister will say more about the health education side, how it links with the other health boards and how it will help education in Scotland to have the new body as opposed to the existing arrangement. Will he also say more about the new Health Service executive?

Mr. Bill Walker: I congratulate my hon. Friend the Under-Secretary on bringing forward the new clause. He will recollect that in Committee the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) and I tried to introduce amendments to the Bill. Because we were not as astute as my hon. Friend and his advisers, we were unable

to come up with an amendment that was technically able to do the job. We put down an amendment which gave us the opportunity to speak——

Mr. Michael Forsyth: It was discourteous of me not to say, in introducing the new clause, that the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) and my hon. Friend the Member for Tayside, North (Mr. Walker) raised the matter in Committee, when I undertook to bring forward amendments. The genesis of the new clause and the other amendments was in that debate. I apologise for not having said that when I introduced them.

Mr. Walker: I thank my hon. Friend for his intervention. I gathered that that was the logic behind the new clause.
That brings me to the point behind the interesting contribution of the hon. Member for Glasgow, Cathcart (Mr. Maxton). He will have realised that the hon. Member for Ross, Cromarty and Skye and I had difficulty in Committee because, if we had made the amendment too narrow, it would have been out of order. We were grateful to the Clerk of the Committee for his assistance in framing an amendment to which we could speak.
I am pleased that the new board will be able to determine policy. Because of the special health problems in Scotland there should be a positive approach to the promotion of health care. I hope that the new clause will receive support on both sides of the House because we are all united on the prevention of health problems.
The meandering of the hon. Member for Cathcart through Ibrox was an interesting way to consider the promotion of good health care. We should encourage more anticipation in sport. The approach of the hon. Gentleman to health care is a splendid example; I give him that.

Mr. Maxton: Almost the only criticism I have of the Scottish Health Education Group is that for so many years it sponsored professional footballers in Scotland and did not put money into activity sports such as running and amateur football, as it should have done.

Mr. Walker: I do not disagree with the hon. Gentleman; we should do more to assist amateurs in whatever activity they are involved. Like me, the hon. Gentleman is a great believer in the fact that we can prevent illness by looking after our own bodies, by exercise, and so on.
Because the hon. Gentleman wandered into Ibrox to talk about public relations exercises, perhaps I may refer to the best public relations flop last week when the leader of his party missed the boat to Dunoon. The chap who caught that boat was not the Leader of the Opposition but the vice-chairman of the Conservative party, myself. If it were a question of missing boats, I might draw the attention of the hon. Gentleman to the early-day motion about that, but I would probably be ruled out of order, so I will not refer to it. I am responding to the hon. Gentleman's meandering into Ibrox park. I would never have dreamt of going into Ibrox park until the hon. Gentleman did so. Because of that I had to respond.
This important debate was delayed because of points of order. The reaction of some Opposition Members to a fairly straightforward question, touching a fundamental aspect of the new clause, that when people earn money writing articles——

Mr. Deputy Speaker(Mr. Harold Walker): Order. The hon. Gentleman should address himself to the new clause about special health boards.

Mr. Walker: The new clause has been the subject of many interesting articles. I hope that you, Mr. Deputy Speaker, are not suggesting that it is wrong for me to refer to them. The hon. Member for Cathcart made his view clear about the support for professional football of the body that the special health boards will replace. If it was in order for him to do that, it must be in order for me to draw attention to the many articles that have appeared in the Scottish media on that matter. I cannot believe that you are suggesting that I am out of order in drawing attention to those articles.
Many of the authors of those articles are hon. Members and they have been commenting in those articles and have been paid for them. Perhaps the hon. Member for Cathcart would like to consider who is writing those articles. He should read the Glasgow Herald from time to time and he might recognise the names of the authors of articles in that paper. The new clause is very important because it will provide the machinery in Scotland to deal with important aspects of health care.

Mr. Robert Hughes: The only part of the Minister's speech with which I could possibly agree was the reference to the importance of health education. That is hardly surprising since my knowledge of health education was gained when I was convenor of the health and welfare committee of Aberdeen town council. The health officer at the time was the formidable Dr. I. A. G. MacQueen, who was one of the foremost protagonists of health education and the role of the health visitor.
I do not intend to discuss health education at length save td say that when the Health Service was reorganised in Scotland and we moved from the old regional hospital boards to the present health boards there was a great deal of concern that the removal of responsibility for health education from local authorities to the new health boards would lead to health education being subsumed under a huge area of responsibility. We were afraid that it would lose its importance and that the focal point would be lost.
I do not want to criticise the Scottish Health Education Group, but I suspect from the Minister's remarks that there is need for a higher profile, a greater focus and more attention to be given to health education. Over the years, health education has clearly not had the impact that we hoped it would have. The health of the nation is not determined simply by the hospital service or by general practitioners. It is certainly not determined by politicians. The health of our nation is determined by good social and housing conditions.
It is incongruous that we spend a great deal of money on unhealthy practices such as drinking and smoking. If we have to declare an interest in either of those pastimes, I must admit to partaking occasionally of the liquids that come from the vine and the rye and I occasionally indulge in tobacco. I hope that that does not prevent me from participating in the debate.
A good life style and good living habits should be encouraged at an early age and health education is extremely important. I would not quarrel with any of the Government's proposals to improve health education. However, I wonder why it is necessary to have such a portmanteau provision as new clause 74.
As the Minister said, the new clause sets up special health boards. However, it states that the Secretary of State
may by order constitute boards, either for the whole of Scotland or for such parts of Scotland as he may so determine, for the purpose of exercising such of his functions".
The Secretary of State is taking power here not just to set up special health boards to deal with health education or with HIV; he can also set up boards in particular parts of Scotland.
5.15 pm
I hope that the Minister does not believe that the new clause will weaken the comprehensive role of the existing health boards. There has been much discussion and argument about the functions of the new health boards. It was decided that they should cover the widest possible spectrum covering primary health care, secondary health care and community care.
We know that community care is to be removed. Will there be a special health board to deal with community care once it disappears to local government? That would seem to be inconsistent, but it might be a possibility. Will there be special health boards in local areas? Will there be special health boards in local areas to deal with specific functions? Does the Minister believe that if a particular health board is recalcitrant about privatisation—and. I regret to say that Grampian health board is enthusiastic about privatisation——

Mr. Michael Forsyth: indicated assent.

Mr. Hughes: I can see the Minister nodding and smiling, but we will return to that point later.
For the purposes of this new clause, if a health board decided that it would not pursue privatisation for particular services, does the Minister have the power under the new clause to establish a special health board to deal with those areas that he wants to privatise? He must give us a clear answer on why he needs special local health boards. He gave no reasons in his opening remarks. It is not good enough to table such broad sweeping new clauses without providing a clear explanation of their meaning.
I want now to consider the Health Service executive I assume that the Minister has legislative authority over that, although he is not taking such powers in the new clause. What is the legislative purpose of the new Health Service executive? Will it be a special health board under new clause 74?
We need to know how much the executive staff will be paid. I have seen estimates that they may be paid as much as £50,000 a year. What binding contracts will be provided? Anyone thinking of taking up such a contract must be aware that if he is appointed arbitrarily with an arbitrary contract, he will be subject to arbitrary dismissal if there is a change of Government.
The Minister cannot provide five-year or 10-year contracts believing that they will tie staff down, because there will have to be compensation if the executive is disbanded if there is a change of Government. I hope that no one will take such a job under the illusion that he has a fat, juicy contract with £50,000 a year and that he will get compensation if we decide that the executive will not exist after the next general election.
The new clause looks innocuous and it would appear to be a reasonable tidying-up measure. Most uncharacteristically, the Minister introduced it in such a modest and


moderate way that it is hardly surprising if we wonder what is going on in his little mind behind his smiling, bland little face. We need more explanation before we accept the new clause, although I emphasise that we support entirely the idea of giving health education a much higher profile and more new money.

Mrs. Maria Fyfe: I begin by declaring an interest in that I am sponsored by the Transport and General Workers Union, although not a penny of that money enters my pockets. It is spent campaigning against Conservative policies in Maryhill—and that is an easy job.
I want more information from the Minister on the proposals for special health boards and health education than he has so far troubled to give us. The Minister has not said anything about how the membership will be decided. We must remember the way in which the composition of the local health boards has been changed over the years, so that more and more people of Conservative persuasion seem to serve on them while fewer and fewer of Labour persuasion are chosen. That makes me wonder how these boards will be chosen. Might trade unionists who are involved in health education find a place or two on them?
What are the Minister's plans for choosing women to serve on the boards? Very few women serve on the public bodies in Scotland—boards of various types—over which the Minister has some influence or control. The proportion is tiny. Women chair only one or two. Generally speaking, those in which women participate in any great extent relate directly to things that are seen as women oriented. I also wonder about the resources that the new health education board will have——

Mr. Michael Forsyth: I may have misheard the hon. Lady, but is she suggesting that very few health boards are chaired by women? If so, she could not be more incorrect. If the hon. Lady checks, she will see that a number of health boards are chaired by women, for example, Lanarkshire and Forth Valley. The most recent appointment that we made—in Forth Valley—was bitterly criticised by the Labour party, but it was another example of another woman being appointed to a health board. Others, such as in Fife and the Western Isles, are also chaired by women.

Mrs. Fyfe: If the Minister had been listening to what I had been saying, he would have heard me refer to public bodies in general, across the whole spectrum. Few women serve on or chair such bodies. Of course, I do not simply want there to be more women—I want more women of progressive views to be involved, who will want to do something for their communities. Clearly, not all women fall into that category—as is only too obvious in this place.
The Minister has not spelt out whether the new boards will have more or fewer resources than the present health education body. I hate to suggest this to the hon. Gentleman in case I am putting ideas in his mind, but has he any thoughts about the bodies being funded by the commercial interests that would benefit from increased health education, such as Outspan and Jaffa? Who knows, perhaps this is the first time that that has entered the Minister's head. I hope that I have not given him a new idea.
I do not see the point of leaving it up to the new boards to determine their priorities and targets. I should have thought that medical advice on the major problems confronting us would be the best way in which they could decide their priorities.
We have enormous health problems in Scotland. Indeed, the Minister identified the problems of heart disease and bronchitis from which we know that Scotland suffers especially. There is not much point in advising people that their housing conditions are unhealthy when they can do precious little about it. Will the Minister run a course in health education for his hon. Friend the Minister for Housing and Planning so that they can do something about achieving the major improvement in people's health that would result if they were removed from the damp-ridden housing that is wrecking their health?
Problems such as drug abuse are widespread in parts of Glasgow. I know that useful work had been done on that, but I should like to know whether special funding will be provided for it. Quite apart from the horrific impact on people's lives if they themselves are abusing drugs and on those of their families, drug abuse creates extremely unpleasant living conditions for their neighbours and those who live in the vicinity. Children in parts of my constituency find needles lying in untended grass on wasteland.
Many health education issues need our attention. I am arguing for women to be involved in the boards not simply on the grounds of sexual equality, but because many health matters affect women especially. Women tend to be greater users of the Health Service, both in their own right and because they bring their children to the surgeries. It would be a pity if we did not ensure that women are involved in those bodies in appropriate numbers, and not only in the tiny minority that is the case now in most of the different boards that operate in Scotland. Obviously, I want women of progressive views to be involved, and not too many Conservative women.

Mr. Archy Kirkwood: I welcome this important new clause. Any idea that was cobbled together by my hon. Friend the Member for Ross, Cromarty and Skye (Mr. Kennedy) and the hon. Member for Tayside, North (Mr. Walker)—an unholy alliance if ever I saw one—must be worth supporting, but perhaps that is going too far.
Since being elected to the House, I have tried to take a particular interest in preventive medicine in its broadest sense because I believe that moving health care in general in the direction of prevention is an entirely good and proper thing, and health education is an important element in that.
The only reason why I am dragged to my feet now is to ask about the independence that the new body will enjoy. I do so because some worrying parallels could be drawn with the situation that arose in 1986 when the right hon. Member for Sutton Coldfield (Sir N. Fowler), the then Secretary of State for Social Services, abolished the health body that was then independent of the Government and established a new Health Education Authority. That provides a parallel with the contents of the new clause. I do not need to remind the House that real misgivings were voiced at that time. When the right hon. Gentleman introduced that change in 1986, he said that he was doing so to deal with the special problems of AIDS. Everyone


supported the move for that reason. However, it subsequently became clear that the Government were using undue influence and bringing to bear departmental methods of working and priorities in a way that was not possible before, when the previous English and Welsh body had more independence from Government Departments.
There is a great deal of value in any health education body having an element of independence. If such a body is to be successful, it must operate in areas that are difficult for any Government because they embrace, for example, dietary provision and nutrition. That immediately involves a confrontation with the direct commercial interests of the food industry. I fully accept the difficulties of that. We have had arguments about sugar and about cholesterol-free diets around which many commercial interests have been built up. Similarly, we must confront the difficult area of alcohol abuse in terms of, on the one hand, what is good for the population's health, and, on the other, what is good for the industry that is supplying liquor of all sorts. There are also similar problems with the tobacco industry, about which I have been concerned for some time.
Any health education body worth that description will have to look closely at the impact of the produce and the products that such commercial enterprises are purveying to the public. If that body is under direct Government guidance and control, that puts the Government in a difficult position. I hope that that matter has been properly addressed and that the things that went so badly wrong in 1986 when the Department in England took over the previous health education body for England and Wales are corrected for Scotland in the future.
Following that train of thought one step further, I hope that the voluntary sector will be able to interface closely with the new body that the Minister is setting up. I also hope that funds will be made available so that it can undertake work in some of the sensitive areas with which the Government find it difficult to cope, such as AIDS. I pay tribute to what has been done north of the border in that area. An awful lot more needs to be done. It is valuable to establish a health education authority to look at the specific Scottish aspects of the development of the disease. I am grateful that the Minister is nodding his assent.
I fully understand that for any Government advertising campaigns are necessary to confront the problem adequately. It is difficult for Government Departments to do so. There is a value in having pressure groups and voluntary groups that can work alongside AIDS sufferers and HIV positive patients in a way that Ministers, officials and civil servants never could. That is no criticism of them; it is simply recognising reality. I hope that the new body will have a wide scope, flexibility and independence and will be free from the influence of the Minister's Department. If not, he will be wasting his time and the body will not succeed.
It would be helpful if we could be given a steer about the amounts of money and the resources that might be available to the authority. Is it likely that there will be new money or will budgets have to be trimmed to give the new health education authority an acceptable budget with which to work? I hope that the Minister will consult widely—I mean widely, to the extent of consulting the voluntary sector—before he puts together the membership of the new body. That, too, is crucial. I agree with the hon. Member for Glasgow, Maryhill (Mrs. Fyfe) that we must have more

women on all such bodies. We must have a spread of membership to embrace all the difficult matters that must be dealt with if the body is to succeed.
I welcome the initiative. The body has great potential for confronting some of the difficulties that are peculiar to north of the border, such as coronary heart disease and short life expectancy, to which the Minister referred. The body can do so only if it is genuinely free of day-to-day Government interference and control.

Mrs. Margaret Ewing: I shall be brief because many of the points that I should have made have been touched upon by other hon. Members. The Minister has shown an administrative commitment to the establishment of the boards and we are asking for details to flesh out the ideas behind them. A great deal of importance should be attached to who the members of the boards will be and what budget will be available to them.
We all recognise the great importance of health education. One point that has not been touched upon by other hon. Members is how the boards will interface with our education system. We all recognise that a great deal of health education work has been undertaken in our primary and secondary schools. We owe a great debt to many teachers, particularly physical education teachers, who, through their classes, have made youngsters aware of the implications of diet and habits for their health. Many parents have told me that they have stopped smoking because such an impact has been made on their children during lessons at school that the parents feel guilty arid give up the habit. Perhaps I should have some children who could come home and give me that lesson because, like the hon. Member for Aberdeen, North (Mr. Hughes), I admit to particular vices.
It is important to know how the health boards will tie in with our education system, and use the expertise that is already present in our schools and the information that the Scottish Health Education Group so readily supplies to them. We want that to continue and to be expanded. It will be interesting to hear what interface the Minister has in mind.

Mr. Kennedy: As the Minister was either generous enough or grotesque enough to give me joint B-film scripting accreditation on the new clause with the hon. Member for Tayside, North (Mr. Walker), it seems appropriate for me to say a few words. My hon. Friend the Member for Roxburgh and Berwickshire (Mr. Kirkwood) described that partnership as an unholy alliance. I hope that the House understands that on these Benches we can speak about that term with particular insight.
I echo the question put to the Minister on the structure that he has chosen. The hon. Member for Aberdeen, North (Mr. Hughes) said that, like so much else in the Bill, the new clause opens up fairly wide-ranging powers. Under various clauses, we have heard time and again that the Secretary of State is taking powers unto himself. More often than not, we are told, "Don't worry because he does not intend to exercise them." Some of us fear that from time to time those powers will be exercised. We should never ascribe to this Health Minister some of the mean motives that might be in the hearts or minds of other Health Ministers, but the successors to his office may want to use those powers in a different way. What safeguards are there?
The hon. Member for Glasgow, Cathcart (Mr. Maxton) referred to prevention when he spoke about sport. The Health Minister is also responsible for sport in Scotland. He wears two hats. I repeat the point made earlier in this short debate, that over the century the greatest contributors to better and healthier living have been improved housing, water supplies and working and environmental conditions. In that context, and without straying beyond the parameters of the debate, I hope that the Minister will recognise that there are slightly wider social obligations, in terms of broader Government social policy. Much of that resides with the Secretary of State for Social Security. We shall go on to one aspect of that later. Those obligations must be borne in mind as well as worthwhile and valuable initiatives such as the Minister outlined.
Like the two other smoking sinners, and as the third member of that triumvirate in the House, and with national no-smoking day almost upon us, such is the extent to which I am moved by the Minister that I shall have a real go this year to kick the habit once and for all.

Mr. Michael Forsyth: I am delighted that, even before the new clause has been accepted by the House, we have at least one convert in the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy). If the House accepts the new clause and amendments, when we lay down regulations to establish the new health boards in Scotland responsible for health education, the hon. Gentleman will be able to give us a full report on the progress that he has made in the intervening period.
The hon. Gentleman was kind enough to raise the matter in Committee when I was considering the report that we had received from Touche Ross and the advisory council. The hon. Gentleman said that the Secretary of State was taking more powers. The new clause and amendments do not give the Secretary of State more powers. They enable him to delegate his powers to new bodies. In that sense, the new clause does not increase the Secretary of State's powers but merely allows him to set up bodies that will act as his agents. That is the constitutional position of the health boards. I pointed that out when we first discussed competitive tendering in Scotland.

Mr. Maxton: Perhaps the Minister will tell the House in what other circumstances he expects the Secretary of State to use the power to delegate responsibilities. For what reasons would he do so?

Mr. Forsyth: If the hon. Gentleman is patient, I shall come back to the point that he raised. I was simply responding to the points raised by the hon. Member for Ross, Cromarty and Skye.
The hon. Member for Ross, Cromarty and Skye also said that housing, water supplies and so on were important for public health. I agree, but he will recognise that both those areas are the responsibility of local government, not central Government. There is certainly much room for improvement in both areas and in local government. No doubt people will take the opportunity in respect of water supplies on 3 May.
The hon. Member for Glasgow, Cathcart (Mr. Maxton) raised several points. He asked why there was no reference in the new clause and amendments to health education and why they were widely drawn. To be

perfectly honest, when we were contemplating what steps we might take it struck me as remarkable that the Secretary of State for Scotland could not delegate his powers to new bodies that he might constitute, as my right hon. and learned Friend the Secretary of State for Health can south of the border. We discussed the matter in Committee and it seemed appropriate that we should give the Secretary of State those powers.
I am surprised that the hon. Member for Aberdeen, North (Mr. Hughes) thinks that there is some Machiavellian plot involved in my moving the new clause. There is nothing sinister or underhand going on. The powers in the new clause and amendments mean that the Secretary of State would have to come to the House to make regulations which would be subject to negative resolution. Therefore, the House would have every opportunity to consider the arrangements in respect of this new health education body.
The hon. Member for Cathcart was suspicious and, in line with the hon. Member for Aberdeen, North, suggested that this was all part of putting the management executive, which we have established in the NHS, on a statutory basis. We do not require these changes in the law to establish the management executive. We have been able to do so. Mr. Cruickshank, the chief executive of the NHS, is a civil servant, not a political appointee. I was distressed to hear what the hon. Member for Aberdeen, North said. I take it that he was not speaking for his Front Bench when he suggested that members of the management executive, who are being recruited to get the best possible deal for the patient, would not enjoy job security under a Labour Government. In that respect they would share the fate of many thousands of fellow Scots, if that is what he sought to imply.

Mr. Robert Hughes: We must get this exactly right. What is the status of the new executive body? Will the individuals be appointed under normal Civil Service terms and conditions? If so, that is another matter. However, if they are to be appointed on individual binding contracts with high salaries, we need to be told. There is a big difference.

Mr. Forsyth: The hon. Gentleman is absolutely right. The appointment of people on fixed-term contracts which are performance related is different. It is also desirable and important. The chief executive of the Health Service certainly is appointed on that basis, as are the general managers of the health boards. That is a great step forward and I am sure that the hon. Gentleman will welcome accountability of those whose function it is to hold the Health Service accountable for the targets which are set in the interests of patients.

Mr. Maxton: All of us would be interested to know exactly who the Minister has in mind for these jobs. The newspapers have said that the chief medical officer for Scotland will be one person on the executive. Who will the others be? I appreciate the Minister's remark about Mr. Cruickshank because he was appointed against the Minister's wishes. The Minister wanted Mr. Laurence Peterken from the Greater Glasgow health board. Is not this a back door through which the Minister can put Mr. Peterken on the executive?

Mr. Forsyth: What the hon. Gentleman says is completely untrue. The appointment of the chief executive


was made in the normal way, on a recommendation from the Civil Service Commission, and was approved by Ministers. The hon. Gentleman should not make such comments unless he is sure of his facts. He is wrong.
The management executive has nothing whatever to do with the new clause. It has come into the debate only because the hon. Member for Aberdeen, North asked me to give an assurance that we do not intend to create a special health board, which is the management executive. I am happy to give him that undertaking which I hope means that we can now leave the matter behind us and look forward to a better managed, better run Health Service. I know that Opposition Members are opposed to that——

Mr. Maxton: Nonsense.

Mr. Robert Hughes: Will the Minister give way?

Mr. Forsyth: In a moment. The Official Report will show that the hon. Member for Cathcart said that we cannot run the NHS like a business, and a business is run in a businesslike manner. A Health Service run in that way will be better able to meet the needs of the patients and those who send us to the House.

Mr. Robert Hughes: The Minister should not be allowed to get away with the statement that Labour Members do not want the Health Service run in a businesslike manner. It is utterly untrue. In all the years I have been involved in the Health Service, whether as a councillor, a member of the regional hospital board or a Minister, we have always been anxious to ensure that it is run properly and we get value for money. That is different from what is happening now. The Health Service is being run not on businesslike methods, but to put business the way of the Minister's friends. The way that it has been prostituted for his political ideals is a disgrace.

Mr. Forsyth: If the hon. Gentleman is arguing that the Labour Government ran the Health Service well, he will forgive me for pointing out that they presided over a cut in the hospital building programme and a cut in nurses' pay of more than a quarter. The contrast with our record could not be clearer. He may not wish me to go over what is certainly ancient history, because it is so long since we had a Labour Government, but perhaps I may remind him of the Labour party's attitude to the appointment of business men to take charge of Health Service management. It opposed that on the grounds that business men were not appropriate. Yet business methods and a businesslike way of running the Health Service are in the interests of patients.

Mr. Martin Flannery: rose——

Mr. Robert Hughes: rose——

Mr. Forsyth: I have been good in giving way and I should make progress, but I give way to the hon. Member for Aberdeen, North.

Mr. Hughes: The Minister should be reminded that the Labour Government set up a special commission to look into nurses' pay. That was done thoroughly. I remember a business man in Aberdeen who was appointed by one of the Minister's predecessors to be vice chairman of the then North-East of Scotland regional hospital board with a

view to making it more business-efficient. He became chairman of the finance committee. Within a year he said, "What are those so-and-sos who used to be friends of mine doing to my Health Service?" Business men who are appointed know what is happening. The Health Service is not being run properly in the interests of patients. and the Minister should stop pretending that it is.

Mr. Forsyth: If the hon. Gentleman is saying that everything is not perfect in the Health Service, I agree. That is why we are introducing the Bill and providing for the service to be run in a more businesslike way. If he thinks that it is any consolation to nurses that when his colleagues were in government they set up a commission into nurses' pay, he does not live in the real world. The Labour Government cut nurses' pay by a quarter whereas we have increased it by——

Mr. Deputy Speaker: Order. This is a long way from the new clause before the House. I hope that the Minister will return to it.

Mr. Forsyth: I apologise, Mr. Deputy Speaker, if to speak of the good news in the Health Service is to stray from the new clause.
The hon. Member for Cathcart asked about the "Good Hearted Glasgow" campaign. I appreciate his kind comments about it. It is a good example of a health board being involved in health promotion and doing it extremely well. That sort of campaign would not be threatened in any way by the creation of a new body with national responsibilities for health promotion, as he claimed. We intend to have a national policy statement about health education for which the new body will he responsible. The health boards will work with the new body to achieve that. We particularly want to place more emphasis on the prevention of coronary heart disease. The campaign in Glasgow and that in my own constituency, which is run by the Forth Valley health board, are excellent examples of what can be done in that area.

Mr. Tom Clarke: Since this seems to be a rather rushed affair, and since the Under-Secretary has referred to the important subject of health education, will he tell the House what consultations he or the Secretary of State have had with people responsible for health education at the moment?

Mr. Forsyth: I do not think that the hon. Gentleman was here at the beginning of our deliberations and lie therefore missed what I had to tell the House——

Mr. Clarke: I was here.

Mr. Forsyth: I am surprised, because I told the House that we had asked Touche Ross to carry out a review of health education policy in Scotland. The company spoke to nearly all the interested parties in health education and produced a report which is now in the Library. I commend it to the hon. Gentleman. It sets out Touche Ross's recommendations, which reflect the views that were given as it went around Scotland speaking to interested groups. The report recommends the establishment of a special body, although not of the kind that we are discussing. Having commissioned those reports, we should proceed with all due speed to ensure that the body is up and running by 1 April next year.
My hon. Friend the Member for Tayside, North (Mr. Walker), who is no longer in the Chamber, raised a


number of important issues. As the hon. Member for Ross, Cromarty and Skye said, we should give him and my hon. Friend credit for having raised the matter in Committee.
The hon. Member for Moray (Mrs. Ewing) asked me about the detailed nature of the body, who would be appointed and other such matters. Assuming that the amendments are passed, that will be decided by the House. There will be an opportunity to discuss the issue in the House, if the hon. Lady cares to ensure that, because the new clause provides for powers to make regulations which will be subject to negative resolution. I have no doubt that we will get a great deal of advice now that we have made our policy clear.
The hon. Lady also highlighted the importance of health education in schools, and I entirely agree. We shall expect the new body to strengthen links with education authorities and schools. When I was Education Minister I was particularly conscious of the great work that is being done in our schools, particularly on drugs and AIDS, and all credit is due to the education authorities involved in that.
The hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) asked me about independence—[Interruption.] Not the kind of independence with which the hon. Member for Moray is concerned. That seems to be becoming less fashionable, if recent polls are to be believed.
The hon. Member for Roxburgh and Berwickshire asked me about the independence of this body. It will be active as the agent of the Secretary of State. I agree that there are times when it is helpful for Ministers to be distanced from some of the campaign that is necessary on a health education fund, for the reasons that the hon. Gentleman outlined. There will be a national policy statement and it will be the job of the board to give effect to it and obviously that will be at arm's length.
I heard what the hon. Gentleman said about the nature of the board, and the composition of chairman and members, and I shall ensure that people with the talent and ability to provide the best possible service will be recruited to the body—as we have done with all the health boards.
The hon. Member for Roxburgh and Berwickshire also asked me about resources that will be deployed. If he looks at the Touche Ross report in the Library, he will see that credit is given for the increasing resources that have been provided. The report points out that this area may have been under-resourced in the past. That was a problem not of funding but of structure. We are determined to commit resources to health education because it is one of our priorities.
The hon. Member for Glasgow, Maryhill (Mrs. Fyfe) asked me about women appointees. I think that we have done extremely well in appointing women to health boards—not because they are women, but because they had the talent and expertise required—and they have done extremely well. The hon. Lady also asked me about funding for drug abuse. She will know that we have made available considerable additional resources to deal with the problems of drug abuse and AIDS. In the space of a little more than a year we have doubled resources. I hope that the hon. Lady will recognise the progress that has been made.
I sense that, having given those assurances to Opposition Members, there may be some support across the House for our proposals. The strengthening of health education is a key link in achieving our objectives for a better health service and better health care in Scotland. I hope that I have been able to persuade the House to support the new clauses.

Mr. Tom Clarke: I do not think that the Minister should be surprised if some hon. Members feel that we should take up some of his remarks, albeit briefly.
The Under-Secretary of State said that he was not sure whether I had been listening to his remarks about the Touche Ross report, but I do not think that he was listening to my intervention. I clearly asked whether people involved in health education had been consulted. He gave no evidence that they had been consulted on the conclusions and the recommendations of the report. Therefore, there is a great temptation for Opposition Members—perhaps because of the Minister's speech—to have greater doubts about the new clause.
In all honesty, perhaps the only redeeming feature is that the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy), who was positive at all times in Committee, made some contribution to the new clause. I hope that he and the House will not mind when I say that the Opposition—having heard the Under-Secretary's particularly vague explanation in response to my hon. Friend the Member for Aberdeen, North (Mr. Hughes), who asked a direct question about the legislative purpose of the boards—will judge the Government's real intentions when we deal with the regulations.
I am not convinced that the new clause represents the answer that all hon. Members would wish for in creating a broad strategy for the Health Service in Scotland, and for the major thrust necessary to deal with heart disease, respiratory conditions and the problem of an earlier mortality rate than elsewhere in the United Kingdom. The Minister did not convince us that much time had been devoted to real consultations on health education. I hope he will not mind if I return to the painful subject of what was once the responsibility of the Scottish Film Council. I think he is now able to distinguish that organisation from the Scottish film library. It works closely with the health education unit, which deserves to be congratulated on the way that it has promoted the campaign against AIDS and drugs. The Opposition want to be absolutely certain that the quality of those campaigns will not be diminished but will increase. We are not convinced, by any stretch of the imagination, by the Minister's arguments. Some of us are worried, in view of his speech, that there he was, sitting on the roof of St. Andrew's house feeding the vultures and coming up with even more crazy ideas about what he will do with the Scottish Health Service.
Notwithstanding the Minister's weak arguments, we shall not oppose the new clause. However, we shall look carefully at the regulations that will be laid before the House.

Question put and agreed to.

Clause read a Second time, and added to the Bill.

New Clause 1

PRESERVED RIGHT TO INCOME SUPPORT

'(1) The Secretary of State shall, in respect of every person specified in Section 40 and who is in receipt of Income Support on the date on which Parts III and IV come into force:

(a) determine whether the appropriate amount of income support for that category of residential or nursing care is adequate to meet the charges levied by the residential care home or nursing home; and where it is inadequate establish the difference between the appropriate amount of income support and the charge; and
(b) pay to that person an additional amount of income support representing the figure determined in accordance with paragraph (a) above except that no such payment shall be made in respect of any proportion of a charge which an adjudication officer considers to be unreasonable, having regard to the nature of the premises and of the services provided; and
(c) by means of annual adjustments, maintain the value of the amount described in paragraph (b) above by reference to an index reflecting the average movement of charges made by proprietors of relevant premises.

(2) In this section:

"relevant premises" has the same meaning as in section 40. "appropriate amount of income support" has the same meaning as in paragraph 5, 6 and 7 of Schedule 4 to the Income Support General Regulations l987.'.—[Mr. Robin Cook.]

Brought up, and read the First time.

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Mr. Robin Cook: I beg to move, That the clause be read a Second time.
Before I turn to the substance of the new clause, I intend to make two comments on why the Opposition have chosen this as the first of the Opposition new clauses to be considered on Report. The Opposition deliberately chose a community care topic to be debated first. The Bill is the response, such as it is, of Ministers to the Griffiths report on community care and their response to the explosion in the numbers of the very elderly which, during the next decade, will be a major challenge to the health and social services.
The clauses on community care are to be found at the very end of the Bill. We were anxious from the moment that we saw the Bill that those clauses should not be ignored. It is a measure of the success of our strategy in Committee—a success that has been much appreciated by voluntary organisations—that we were able to pace our Committee debates in such a way that four days were spent on debating those clauses. We were equally determined that community care and the needs of the elderly should not be forgotten on Report. It was partly for that reason that we chose to debate new clause 1 at the start of our debates on Report.
I am sure that it has not escaped Ministers' attention that there is a second reason for the Opposition having chosen first to debate new clause 1: this is an issue which unites both sides of the House. I stand at the Dispatch Box under the novel burden of speaking to a new clause that has attracted the signatures of more than 30 Conservative Members. I respect their support, in return for which I shall seek to be as non-partisan as it is possible for me to

be. I may have to compensate later tonight for that non-partisan spirit, but on this occasion I shall endeavour to curb my enthusiasm.
It is understandable that so many Conservative Members should want to support our attempt to provide justice for the people who are referred to in the new clause. Ironically, Conservative Members represent more social security claimants than do Opposition Members. They represent constituencies in parts of the country that tend to have more private residential care homes. I doubt whether there is a single Conservative Member who does not know of at least one constituent in his or her constituency who falls into the trap that is addressed by the new clause. The trap catches elderly residents who entered private residential care homes or private nursing homes after being assured by the Department of Social Security that it would meet the charges through income support. Now, however, they find that they are being short-changed on income support and that they have no means of bridging the gap.
During the last two months I have seen and heard of so many such cases that it is difficult for me to select only one for the purposes of illustration. However, I shall share with the House the experience of Mrs. Renninson, who appeared with me at a press conference last week. Mrs. Renninson's father experienced a stroke at the age of 86 and had to go into residential care. He was admitted to a home that was able to cope with his needs. However, from the moment that he entered the home he faced the familiar problem that the charges increased faster than the increase in income support. Four years later, at the age of 90, he was put out of the home by the owners. Seven weeks later he died. The discontinuance of familiar surroundings is one notorious way in which death among elderly people can be precipitated. However, we cannot tell whether in this case death was associated with a change in surroundings; we can only make a reasonable presumption.
When Mrs. Renninson spoke to the press conference she said that she felt that it was a mercy that death occurred after her father's second stroke because he really did not know what was happening to him. As I listened o Mrs. Renninson, I thought how amazingly reasonable and calm she was, despite all that she had been through.
I am bound to ask how we, as a legislature, can have permitted circumstances in which elderly men and women—too confused and too disoriented to know what is happening to them—are evicted from residential care homes because the benefit that they receive, in the name of this House, is not sufficient to keep a roof over their head.
That case occurred in the constituency of the Minister for Health, who is responsible for community care. In fairness to the Minister, Mrs. Renninson told me that she appreciated the support that she received from the Minister during the years throughout which she struggled to meet the fees at the home. As Mrs. Renninson expressed it to me, the Minister had written many letters of support to her, but unfortunately she was trapped because of the way in which the regulations are framed.
The new clause provides the House with an opportunity to change the regulations. It would help many people who are in the same position as Mrs. Renninson's father. Study after study throughout the past two years has confirmed that the present level of income support for those in private residential care is hopelessly inadequate to meet the fees. Only last month, Counsel and Care for the Elderly


published its latest survey which showed that, of the homes it had investigated, only one in three charges fees that are within the income support limits. When it looked at homes in the London area, out of the 132 homes that it surveyed only seven charged fees that were within the income support limits.
The British Federation of Care Home Proprietors says that the average shortfall is £40 a week. The Independent Hospitals Association says that the average shortfall is £60 a week. That shortfall is calculated on the basis of typical weekly expenditure per resident. It makes no allowance for capital borrowing and it allows only £14 a week for the food of each resident. When I referred to that figure in Committee, perhaps in an unfortunately partisan spirit I asked how many Conservative Members could feed themselves for a week on £14. In the non-partisan spirit in which I move the new clause, I ask my hon. Friends how many of them could feed themselves for a week on £14.
Lest it be thought that the shortfall that the figures represent includes an excessive and unreasonable profit for the homes, let me consider the case of those residential care homes in the private sector that do not seek to make a profit. The National Federation of Housing Associations has made a survey of 500 homes. All of them are provided by voluntary organisations or housing associations. All of them are organisations that the Government seek to foster. In none of these cases is a profit, excessive or otherwise, being made. Few of the 500 homes came up with charges within the limits for income support. In most cases they were £30 above the limit, and, in one fifth of cases, more than £60 above the limit.
Counsel and Care for the Elderly has sent to a number of hon. Members examples of the cases in respect of which it has been asked for assistance. I should like to refer to two or three of them. The first demonstrates beyond any argument how even organisations that do not seek to make a profit cannot run their homes within the limits set by the Department of Social Security. Let me cite the case of Mrs. B, aged 95. In 1985 Mrs. B moved into a voluntary nursing home run by an order of Roman Catholic nuns. Over the past five years the nuns have been faced with escalating costs, and the fees of this non-profit-making home are now £275 per week. Mrs. B is therefore unable to meet the full charge out of her income support. Her daughter is retired and is unable to make up the shortfall. Six charity funds have now been persuaded to make long-term grants, leaving the retired daughter to make what is described as a manageable contribution to top up the social security. This is a home run by nuns—people who patently do not seek to make an excessive or unreasonable profit, people who have themselves taken vows of poverty, yet who, within the limits set by the Department of Social Security, cannot make ends meet. I should like the House to note how many charities had to be approached in order that the gap might be bridged.
Let me refer to another case history that has been supplied by Counsel and Care for the Elderly. It relates to a woman of 92 who has been in a private nursing home in Sussex for four years. She is confused and requires heavy physical care. The fees of the home have increased steadily, and there is now a shortfall of £90 per week. As in the other case, this lady's only daughter is retired. Nevertheless, she contributed her entire state pension to try to meet the

amount by which income support fell short of the fee. That situation cannot be maintained for long. Currently. Counsel and Care for the Elderly is negotiating with 10 separate charities to meet the top-up. It says that if all 10 can help, Mrs. V will be able to remain in the home.
What makes many of these cases so perverse is that they involve elderly people who were placed in private residential care by NHS hospitals desperately anxious to recover the beds that were being occupied. Time and again those people, having been placed in that care, are left in an impossible financial situation. Just before coming to the Chamber I received, by fax, from the National Association of Citizens Advice Bureaux, details of the latest case. It involves an elderly lady who is in need of full-time nursing. She is incontinent and is unable even to feed herself. She has been in a private nursing home for a number of years. The home has now asked her son to remove her because it is no longer prepared to tolerate the loss that it sustains by way of the difference between income support and the fee that it charges. The irony is that neither the son nor the lady herself was responsible for her being in the nursing home in the first place; a local NHS hospital put her there without consulting the son because it wanted access to the bed that she was occupying.
6.15 pm
As this matter was debated by the Select Committee, we have the advantage of the Committee's report, which came out last week. It confirms every point that was put to Ministers in the Standing Committee on the Bill. In particular—and I found this startling—the report confirms that the Government themselves admit that income support levels do not meet the needs of many of those in private residential care. It quotes Ministers as having said that 58 per cent. of people in private residential care in receipt of income support are paying fees that are within income support limits. Therefore, even on the basis of the Government's own figures, two out of five of those in private residential care are faced with fees that are outside income support limits.
I have to say to the Secretary of State for Social Security, whose presence for this debate I welcome, that, given his knowledge that 42 per cent. of those people are now faced with charges that exceed income support levels, it is impossible to believe that the uprating this year or last year turned on a careful calculation of what it would take to meet a reasonable fee.
As the House will be aware, the uprating that was announced last autumn will take effect next month. I remember the figure particularly well—it is £10—as at that time I was shadowing also the Minister who will reply to this debate. I can tell the House how the right hon. Gentleman arrived at that figure. He did not do so by measuring the fees and by doing a careful calculation of what was needed; it just happens that £10 is the round figure nearest to 5·4 per cent. of the £190 that was the previous limit for care in private nursing homes. This is the standard application of the uprating, across social security, to these levels, although that uprating is hopelessly out of touch.
Last year, for instance, private nursing homes had to meet the cost of the nurses' pay award. This year they have to meet the additional burden of high interest rates. These place a particularly heavy burden on those homes that borrowed in order to get into business. The Select Committee's report quotes the Minister as having said that


it was never intended that fees should be met in full. In other words, it was never intended, and apparently never claimed, that income support levels should be measured against the fees of homes. I put it to the Secretary of State and to the Minister of State that, as a simple statement, that is just not true.
The original basis on which income support was made available to people moving into private residential care was that of the regulations on board and lodgings, under which local social security officers were empowered to meet the full reasonable cost of accommodation. There is no suggestion there that it was not intended that those payments should not meet the full cost of private residential care. Let me put to the Secretary of State what, in a sense, is a more important consideration: that statement not only is not true in history but is a novel principle in social security law. The whole function of income support is to meet the full subsistence needs of those in receipt of it. After all, they are broke. They have no other means of subsistence. If it were otherwise, those other means would be deducted from the income support entitlement.
That prompts a question to which a straight answer from the Secretary of State would be appreciated by many people: if he and the Minister of State are now saying that it is not their intention that the full reasonable charges of these homes should be met through income support, who is it intended should make up the balance? Who should absorb the shortfall? Will it be the homes? Are they expected to make a loss as a condition of accepting as residents people who are on income support? I can tell the Secretary of State what their response will be. Indeed, there are two possible responses.

Mr. Andrew Bowden: As the hon. Gentleman will know, I put my name to the new clause. I put this question to him in good faith so that I may be able to think through the point that he is making. I am sure he agrees that, under the old system, there was gross exploitation by a proportion of nursing home owners, in the sense that they increased their rates knowing that the individuals concerned would have only to apply to the DHSS, as it then was, to have the shortfall automatically made up. We are now in a new situation. I understand completely the points that the hon. Gentleman is making. However, I ask him quite genuinely how he thinks this problem should be overcome. It seems to me that there are two possible solutions: either there should be a blanket increase in all levels, or either the DHSS or the social services departments of county councils should be allowed to assess cases and make a proportionate increase to meet the costs. Which is the best path to go down—or does the hon. Gentleman have an alternative?

Mr. Cook: The hon. Gentleman makes a rich intervention and it will take me a little time to respond to it. On his point about the genesis of the situation, I do not wish to introduce a partisan note, but if it were possible for us to go back to 1980, we would not have wished to start out on the path that the Government followed. We would have preferred the large sums that were made available through the social security budget for private residential care to be channelled into local authority residential care, which would have meant that we would not now face our present difficulty.
Ministers made the deliberate decision to subsidise the expansion of private residential care through social security provision. The resultant expansion cannot have come as a surprise to them, because the policy was intended to achieve that expansion. I accept the point made by the hon. Member for Brighton, Kemptown (Mr. Bowden); indeed, the Opposition criticised the consequences. Some homes came into existence at that time with, let us be frank, an eye to the main chance, to take advantage of the new bonanza.
I would not necessarily criticise the 1985 system to introduce fiat-rate payments for people in private residential care, although I believe that they should have been subject to regional variation. I criticise the fact that, since 1985, those flat-rate payments have been uprated in such a meagre and unrealistic way that they have precipitated a major crisis among those in receipt of those allowances.
To follow the point raised by the hon. Member for Kemptown, and letting all that go as water under the bridge, how do we get out—if that is not a hopelessly mixed metaphor? Perhaps I should say, how do we get up-river from where we are? As the hon. Gentleman said, there are two alternatives. The alternative proposed in my new clause, to which the hon. Gentleman has added his name, is that we should oblige the Department of Social Security to carry out a realistic evaluation of what charges are reasonable. The new clause gives protection and gives the Department the right to refuse to make payments where the charge is unreasonable and to pay the money to the resident.
I am not immediately attracted to the alternative of empowering local authorities to top up the amounts. Every other clause on community care imposes additional burdens and liabilities on local authorities. The Opposition doubt whether those local authorities will achieve the necessary finance to discharge them. I should be hesitant about passing on to those local authorities the additional expenditure of meeting that top-up. I can warn the hon. Member for Kemptown about the immediate arid predictable consequences of such a change: the Secretary of State for Social Security would never uprate those limits again and the burden would fall on local authorities. That is why I chose the path followed by the new clause. I hope that I have responded to the points raised by the hon. Member for Kemptown without jeopardising his support for that approach.
To return to my previous remarks, I was posing to the Secretary of State this question: who does he expect to meet the top-up payment if Ministers no longer intend to meet the full bill? Is it the home? Is it expected to absorb a loss? If so, the home can make two responses. First, it can reduce the facilities that can be made available to people on income support, and that is already happening. A study carried out last year by a firm of financial analysts discovered that only 11 per cent. of homes providing private residential care were willing to provide single rooms for residents on income support. Virtually 90 per cent. now provide only shared accommodation for such residents. Those homes have drawn to our attention the fact that two-tier accommodation is emerging in the private residential sector. The National Association of Citizens Advice Bureaux refers in its briefing to many hon. Members to its information that there are homes where residents on income support receive inferior meals compared with other residents. I cannot believe that any


hon. Member would knowingly wish to have a public policy that resulted in that tasteless, undignified and damaging discrimination.
The second response that a home can make is simply to go bankrupt, and a number of homes are contemplating making that response. In Standing Committee, the Minister of State was good enough to say that she was tremendously impressed by the work of the Anchor Housing Association for the Elderly. I do not know whether she has had an opportunity to study the Select Committee's report, but it contains the evidence that that association provided to the Select Committee. The Anchor Housing Association said that its shortfall was £30 a week per resident and pointed out that in 1988–89 the association lost £250,000 on its residential care schemes, which, as the association said, was
a loss it cannot, as a charity, continue to sustain".
If it is not the homes that have to absorb the top-up amounts, will it be the relatives? I put it to the Secretary of State, who knows social security law as well as any other Member, that the liability to pay the fees is a liability on the resident, not on the relatives. In any event, often those relatives are elderly. We are talking about residents of private residential care homes who are in their 90s. It is in the nature of people of that age that their sons and daughters are themselves retired. As hon. Members will have seen from the briefing circulated to them, NACAB knows of at least one retired pensioner couple, in Cheshire, who have been obliged to take part-time employment solely to pay the top-up on the fee charged for their mother's accommodation.

Sir Dudley Smith: Does the hon. Gentleman agree that one of the tragedies of the problem is that, however severely incapacitated, the elderly person may live on for 10 or more years? I know of someone who lived on for 17 years. Even if the relatives have reasonable funds, they can soon be dissipated and they could be in penury.

Mr. Cook: The hon. Gentleman makes a fair, although infelicitously expressed, point. There is no doubt that one of the great stresses felt by relatives with an elderly parent in this position is that they have no idea how long it will continue, so they have no idea whether they will have any savings left. They do not even know whether their savings will last long enough to keep their relative in private residential care. When their savings are gone, who will meet their liabilities when they in turn require private residential care?
I come to the last possibility in terms of who fills the gap. Are the residents expected to make up the balance? If so, how? By definition, they are people who have no income of their own, except for the £10 a week that they are allowed for personal expenses. Although it is contrary to social security law, many of these residents do not receive even that miserable personal allowance; it goes to fill the gap on the fee, leaving those residents with no money for telephone calls home, stamps and toiletries and even, for some, no money to purchase the incontinence pads that they need but now cannot obtain on prescription.
Ministers have a wonderful phrase to describe what will happen to people in those circumstances under the Bill. It

is said that they will have "preserved rights". There is no security in having preserved rights that will leave people unable to afford toothpaste or incontinence pads. The reality is that for "preserved rights" we should read "excluded rights". The only provision in the Bill that affects those people is clause 40, which is in the Bill with only one purpose—to exclude those people presently in private residential care from the new arrangements to take effect from April 1991.
There is a real danger that those people will become the forgotten people. Local authorities will have no powers to make the top-up, the Department of Health will have no duty towards them and the Department of Social Security, which plainly regards them as imposing irritating costs on the social security budget, wants to be shot of them as fast as possible.
I hope that the House will not be bought off by the formula that the Minister of State put to the Committee when we debated this matter. The Minister drew attention to clause 40 on the basis that
there is scope for making a regulation power to provide for people who otherwise would be homeless or suffer severe hardship in the ultimate circumstances."—[Official Report, Standing Committee E, 13 February 1990; c. 866.]
In other words, it would be possible to contemplate regulations that would protect the position of those people at the moment of eviction.
That proposal does not address what happens in the years leading up to the moment of eviction. We are talking about people in their 80s or 90s. We cannot ask them to sleep easily in their beds on the basis that there may be regulations to cater for them at the point of eviction when the home finally boots them out. Moreover, such a regulation would be entirely pointless because the bizarre result of clause 39 and clause 40, read together, is that if the home evicts a resident and that resident qualifies for assessment by the local authority, qualifies under assessment as being eligible for residential care and is placed by that local authority in another residential care home, he becomes a new resident under the Bill at that point and will qualify for top-up.
We are creating a ludicrous message to send out from this House to the owners of private residential care homes. We are saying to them, "If you are reasonable, if you absorb the loss, and if you do not evict the residents, we shall not help. But if you are unreasonable and evict that resident, we shall intervene and meet the bill." I cannot think of a more confused or hopelessly limited response to the problem.
The truth is that that response is intended not to meet the problem but to defuse the political pressure to solve the problem. I urge the House not to be defused. I can guarantee Conservative Members plenty of opportunities for partisan votes in our proceedings on the Bill. They will have the opportunity to redeem themselves in the eyes of the hon. Member for Derby, North (Mr. Knight) before the night is out. I beg them to vote not to please the hon. Member for Derby, North on new clause 1, but to assist their constituents. I commend the new clause to the House.

Miss Ann Widdecombe: I am grateful for the opportunity to take part in the debate, which concerns the most vulnerable of our constituents. The Government are to be congratulated on their recognition that the present position is unsatisfactory. If they had not recognised that, they would not have brought about the courageous and welcome changes in their implementation


of the Griffiths report and in the Bill. However, in saying that the proposals will relate only to elderly residents who come into private residential homes in future, the Government have eliminated from their wise and humane reforms all who are currently in such homes and who are having to suffer the unsatisfactory position that has led the Government to make changes in respect of future residents.
The hon. Member for Livingston (Mr. Cook) has quoted several of his constituents and I suspect that we shall hear many specific cases tonight. I have raised the issue on many occasions, as has my hon. Friend the Member for Romsey and Waterside (Mr. Colvin), who deserves the thanks of the House for the persistence with which he has raised the matter over the past year. We have raised the topic in Adjournment debates, in Consolidated Fund debates, in the inquiry held by the Select Committee on Social Services and in many other convenient fora. I record my gratitude to my hon. Friend the Under-Secretary of State for Social Security for her many letters to me in response to a particular problem with one of my constituents. That problem is not solved and cannot be solved under the present circumstances. Although I have quoted the case of Florence Smith so frequently that she has become almost a byword to describe such a situation, I have many other cases.
It is a question not only of the problems of our immediately suffering constituents, but of the effect that lack of recognition of the problem to the point of being unwilling to solve it will have on future provision for the elderly. It has been estimated that we need to provide about 40 new beds a week if we are to be able to take care of the ever-increasing number of elderly people by the end of the century. That means that there must be an incentive, and not a disincentive, to the homes to expand and to build them in the first place.
There have been two principal reasons for the immense distortion between the charges being levied by the reasonable homes—I set aside for the moment the unreasonable homes—and the level of income support. First, there has been an immense rise in interest rates which means that any home that has new property attached to it, or is a new property itself, is having to pay immense sums to service the capital investment. The owners have to pass on those sums, which is not greed or unscrupulous profiteering, but basic business sense such as the Government normally applaud. Secondly, there was a welcome and wholly justifiable rise in the pay of nurses the year before last, when the average rise was 15 per cent. Once again, that charge has to he passed on in our nursing homes.
It is significant that some of the homes that have managed to depress their charges artificially are those where the proprietor is herself a qualified nurse and can, therefore, take on many of the duties that would normally fall to other staff. However, if she is also to take on more residents—as she must if we are to meet our target for caring for the elderly—she will be unable to carry that burden indefinitely. That means that she will have to employ qualified staff at an ever-increasing cost, which also has to be passed on.
Other distortions have been caused by regional variations. An established home with no new building in the north-west, for example, may be able to cope and set a charge within the level payable under income support, but there is no way that that can be done in areas where

property is vastly more expensive, such as the south-east, and where the home is new. It is not insignificant that many Conservative Members who first started to draw attention to the problem have come from areas where property is expensive.

Dame Elaine Kellett-Bowman: Is my hon. Friend aware that even in the north-west it is extremely expensive for charities such as the Abbeyfield Society, in which I have a particular interest, to build extra care homes, service the debt and run them?

Miss Widdecombe: My hon. Friend is right and I was not suggesting that the problem did not exist in other parts of the country. While the problems in the south-east are extra acute, we must examine the issue on a nationwide basis.
I shall rehearse again the case of Florence Smith. She is aged 93 and until January 1989 was happy in a residential home, where she could afford the charges. Her income support more or less matched them and there was no problem. Then, like many elderly ladies—many of them much younger than 93—she developed specific nursing needs and could not be accommodated in a residential home. She was transferred to the Poplars, a reasonably priced nursing home in my area. Having telephoned my constituency to check on average charges, I assure the House that the home's charges are most reasonable. It is well respected, well known and a much sought after home. In other words, it is not a ruthlessly profiteering establishment. Florence Smith was moved there and it immediately became apparent that the total benefits payable to her would not cover the costs involved. At that stage the gap was about £10 and was manageable by her daughter. But her daughter depends on a pension, so as the gap grew and the £10 became a larger sum, the pressures on the daughter increased.
The Florence Smiths of this world remain in such homes largely because the homes subsidise them. There must be a limit on how long we can expect the better homes to go on doing that. Somebody entering a home at the age of 93 may have six or seven years left, and the relatives are faced with the problem of meeting the ever increasing gap in payments. That is bad enough. But for somebody aged 70 with nursing needs and with perhaps 20 years to spend in a home, the relatives face an extremely worrying prospect.
I could detail other cases, such as that of a professional, quite well-off couple who faced great problems. The wife developed Parkinson's disease, the husband could not look after her at home and there were no children able to help. Eventually she was moved into a nursing home. The husband took responsibility for that decision and he has run down his capital to the point where there is nothing left. What is to happen to that lady? The benefits available to her do not cover the charges.
Last Saturday a lady told me that her father was terminally ill. Generous income support is available to the terminally ill and that lady has put her father in a home where the charges are eminently reasonable. Indeed, they are on the low side for the area. Yet those charges are not covered and the gap is £50 a week, which is a lot of money. The lady in that case is of working age, and told me that she would be willing to go to work to keep her father in


that home for the last two or three months of his life. Unfortunately, she must also care for a sick son, so she must stay at home and cannot go out to work.
The new clause poses the basic question of who pays. There is no answer to that question in any of the provisions that the Government have suggested. They have acknowledged the problem and have taken many courageous decisions, and we are grateful for that, but all hon. Members have in their constituencies cases such as that of Florence Smith and they know that there will be more of them with the passage of time. In other words, the problem will grow in magnitude and certainly will not go away.
What happens if nobody pays? The Florence Smiths of this world fear what will happen to them if they are turned out of their homes. I do not paint a terrible picture of people being turned out of homes and wandering the streets with nowhere to go, but a sick elderly person in that situation, who either has no relatives or whose relatives cannot cope, will have to go into hospital. It is not even a cost-effective option to transfer people from homes to hospitals.
The Government's policy of closing the larger mental hospitals with the aim of getting people cared for in the community is jeopardised by the situation I am describing. The sick elderly will be returning to hospital, from where nobody will be able to discharge them because there will be nowhere else for them to go. That will put an enormous strain on the Health Service and on the individuals.

Mrs. Alice Mahon: Is the hon. Lady aware that we have lost from the NHS about 6,500 beds in which many of the elderly people about whom she is speaking used to be accommodated? It is not realistic to suggest that returning the sick elderly to hospital is an option because there are so few long-stay beds available. I worked on a geriatric ward in the early 1980s. At that time the Government encouraged the practice of lists of private homes being put up in wards so that relatives could read them and consider putting their elderly folk into homes. There are no beds available in the NHS to take people on a long-term basis.

Miss Widdecombe: I accept that the option is limited, but the fact remains that if someone is evicted from a home, that person must go somewhere, and if he or she is sick and has nursing needs, the inevitable end is a hospital. I accept that that will put immense pressure on the limited facilities that exist.
We must also consider the problem of unreasonable fees. The Government are right to say that, whatever system is created, we must not encourage homes to increase their fees by £20 the instant income support is increased by £20. The Government are right to fear that happening. That is why the proposal in the new clause—that an adjudication officer should be able to refuse to pay any part of fees that appear to him to be unreasonable—should take care of the situation.
The problem of fees is bound to arise with new residents. Nobody is saying that a contracting authority, when taking a certain number of beds in a home, will say, "No matter what you charge, we will go on paying it." There must be a system by which authorities can negotiate

reasonable charges. That process will establish what is a reasonable charge and, once established, it can be applied to existing establishments. So, because of the Government's proposals, the bogy of the unreasonable charge will be less real than it may have been in the past. That will certainly be the case after April 1991.
The new clause provides an adequate solution, and while the Government may complain about its wording, its aim is right. If we do nothing, the most vulnerable of our constituents will suffer greatly. Homes will have no incentive to build and expand when such developments should take place. Undue pressure will be placed on hospital services, which are already highly pressurised.
While I support the Government totally in their general aims in the matter, I urge hon. Members to support the new clause and thereby protect existing residents, whose situation, we are told, will remain the same. In other words, it will remain grossly unsatisfactory, a grievous worry to them in their declining years and a growing burden for their relatives.

Mr. Frank Field: I support the remarks of my hon. Friend the Member for Livingston (Mr. Cook) and the hon. Member for Maidstone (Miss Widdecombe). There are honourable reasons why many of our constituents find themselves in the land of limbo. I refer to our desire to offer our older citizens a better deal than they got in the geriatric wards of the past. Such a better deal appeared to be offered by many of the residential and nursing homes that sprung up.
In the same spirit in which my hon. Friend the Member for Livingston moved the new clause, I do not wish to spend time drawing attention to the number of times that Opposition Members begged the Government not to go down that road—or, when they were going down it, not to have a gatekeeper to prevent expenditure from expanding, whether people needed to go into residential care or not. As the hon. Member for Maidstone said, we are now in that position, and must address ourselves to the question of what to do to protect some of our most vulnerable constituents.
It is important to underline that we are discussing this matter tonight because there was a genuine agreement on both sides of the House that the geriatric ward was not the most desirable place for people to end their days. Nevertheless, it is also important to remind the House, and people outside, that when we were offering the alternative there was never any question that families would have to foot bills, let alone large bills.
There has been a significant change in what I regard as the rights of citizenship. We are talking about people who may have been through two world wars; many of them have never been unemployed, and they have paid all their rates and taxes. One of the benefits that they thought would result from the contract struck with the state was the certainty that, if they needed to go into hospital or have nursing care, they or their relatives would not be faced with a bill. Now we discover that, because we wanted to offer them a better deal and because hospitals thought that it was a way of cutting costs, they and their families will face the sort of charges that the hon. Members have mentioned.
Giving evidence to the Select Committee on Social Services last week, a witness from the Alzheimer's Disease Society said that families faced a deficit of £90 per week. As was pointed out by both the hon. Member for


Maidstone and my hon. Friend the Member for Livingston, the deficits are growing. The Government must acknowledge that there are now pressures from the National Health Service, which will make the position worse. The Committee also heard evidence from clinicians who look after the Acton hospital in west London, which has a £1·5 million deficit. Some of those clinicians feel that the authorities are rushing into a scheme with the private sector in the hope of closing all the geriatric beds, because even under the current Government terms—which in the long run may prove unsatisfactory to the families of patients—as a result of closing its geriatric beds, the hospital will be able to halve its deficit. The picture painted by my hon. Friend the Member for Halifax (Mrs. Mahon), of those beds no longer being there when the ambulances bring people back, is a reality.

Mr. Ian McCartney: A constituent of mine was informed that her aged mother had only three or four months to live, and that the consultant required the bed. She was not given a choice, and her mother was placed in an old people's home. Owing to nursing care and her own abilities, that old lady was still alive 18 months later. However, the fee in the home was more than £60 per week in excess of the family income.
My constituent must now work part time, and she is assisted at the weekend by her son. The doubly incontinent 87-year-old woman is now cared for at home because the old people's home could not continue to keep her: the family could not meet the £60 per week deficit. Their family life has been destroyed, and they are distraught. There is no possibility of their finding care or respite in the public or private sector, because that facility has been denied to them.

Mr. Field: I am always pleased to give way to my hon. Friend, especially when he takes me on to my next point.
We have now entered a new phase: there is no individual test of income on the recipient, but in respect of many families we have returned to the hated household means test. When Ministers appeared before the Select Committee, they made it plain that they would not tolerate that when the new scheme came into existence, and we applaud that. However, those who are already caught in limbo will continue to have a household means test applied to them.
The examples given by my hon. Friend the Member for Livingston and by the hon. Member for Maidstone show that even families that want to make up the difference often cannot, because they are pensioners themselves. What shall we do about them, and also to prevent the position from deteriorating? As my hon. Friend the Member for Livingston said, once the new scheme is in operation we know perfectly well what decent owners of nursing homes will do. They will arrange swaps: ambulances will move between homes, because once an ambulance touches down in a new home the person will be a new resident, and the fees will be paid in full. We can decide tonight whether that is desirable, and whether the Government should be building that into the Bill. The hon. Member for Maidstone asked what would happen between now and the time when the new reform is implemented—and beyond, for those who are caught in limbo. Those residents will face eviction when their families have been broken by the cost of trying to make up

the shortfall in fees, or when the owners face bankruptcy because they can no longer continue cross-subsidising—either from other tenants or from their own reserves.

Mr. Anthony Beaumont-Dark: I, too, am a sponsor of the new clause. Does the hon. Gentleman agree that one of the arguments of those opposing the new clause is that we are asking for a blank cheque—that anything goes, and that anything that is asked for should be granted? Does he further agree—given his very proper record—that all that those who support the new clause are saying is that it should be costed out? Of course, the state should not be penalised, but for goodness sake let us not penalise those in the homes, and throw them on the scrap heap.

Mr. Field: I am pleased that I gave way to the hon. Gentleman, as his remarks take me on to my next point.
I recall a statement that was made by Ernest Bevin. He said, "When looking at a motion, do not bother to read the text; see who is moving it." Let me point out to Conservative Members, who may be worried about the new clause giving a blank cheque, that the name of the hon. Member for Maidstone is on the motion. The hon. Lady would not be proposing any solution that was in the nature of a blank or open cheque. Both she and my hon. Friend the Member for Livingston have tackled that argument head-on. We are not pretending that, if we signed a blank cheque, all those who provide private residential or nursing care would behave honourably to the taxpayer: the sad fact is that they would riot. Therefore, built into the new clause is the important proviso that the costs should be covered if they are reasonable. It is not for us to decide whether they are reasonable; that is for an adjudication officer appointed by the Department of Social Security.
The new clause does not create a blank cheque. We are not just throwing money at the problem. We are targeting it and we are discriminating in the help that is to he given. I hope that people will be mindful of the gains that have been made. We have moved away from the situation where many of our older constituents could expect care, freely given, in the hospital to a much better quality of care in many of the residential nursing homes in our constituencies. Our constituents went there thinking that their fees would be paid in full, but a growing number, almost half of those on income support, are not having their fees paid in full and, increasingly, families cannot meet those fees.
We have a chance tonight to ensure that that system does not continue and to deal some justice to some of our older citizens who have paid their rates and taxes during long and often distinguished lives in order to ensure that they do not face a summary eviction or a crude attempt to beat the Government at their own game by moving them around in ambulances. I hope that the House will agree with the arguments put so well by my hon. Friend the Member for Livingston and the hon. Member for Maidstone and will accept the new clause.

7 pm

Mr. Michael Brown: I apologise to the hon. Member for Livingston (Mr. Cook) for being unable to hear his opening remarks, but I was interested in the comments by the hon. Member for Birkenhead (Mr. Field). However, I am not convinced about the new clause. They, along with my hon. Friend the


Member for Maidstone (Miss Widdecombe) and others who have signed the new clause, do not see the new clause as a blank cheque, but it would allow benefits for people in private old-age pensioner homes to be uprated to whatever a home charged.
We should be aware that a large variety of private nursing homes offer many different standards. There are those that offer poor standards and there are those that offer all sorts of luxurious standards. My family live in west Sussex, so I recently had the opportunity to visit one of the cream of the nursing homes on the south coast, the costa geriatrica. It was a wonderful home with superb standards. All its residents were offered a glass of sherry every morning. [Interruption.] I make no complaint about that. It is important that all private homes should aspire to the best service for the prices charged. But we must acknowledge that there will always be homes that will try to row in behind the standards set by the most expensive homes. Even the most expensive homes will have residents in receipt of the full benefits paid by the Department of Social Security.
It may not be obvious in the new clause, but we are in danger of writing a blank cheque. How on earth will the Secretary of State be able to provide the resources for the individual adjudication that the new clause invites?

Miss Widdecombe: I must ask my hon. Friend, with courtesy, not sarcasm, whether he understands what is being proposed. How will the Secretary of State determine between those variable charges for new residents? If he can do that for new residents, he can do it for existing residents.

Mr. Brown: I cannot accept what my hon. Friend says because the private sector offers a variety of services.

The Secretary of State for Health (Mr. Kenneth Clarke): I am not sure which Secretary of State is being referred to, but I can assure my hon. Friend that this Secretary of State for Health has no intention of leaping in to try to decide what is a reasonable charge for each person under the new arrangements. We all accept that the new arrangements are a big improvement on the arrangements that we shall be glad to see the back of, as the hon. Member for Birkenhead (Mr. Field) said, but under them the local authority will have to assess an individual's needs for residential care and will then have to negotiate with a home that is acceptable to that client what the local authority is prepared to regard as a reasonable contract. That is not the same as addressing each existing resident in whatever home of whatever quality he or she might be in now. I share my hon. Friend's confusion, because that point has been slicked over in all the speeches so far.
The new clause cheerily says that there should be no payment beyond that which is reasonable, but how on earth is the Department of Social Security's adjudicating officer meant to decide what is reasonable? Does it mean reasonable for that resident, reasonable for that home or reasonable on the costs of a particular proprietor? My hon. Friend is being barracked, but he is making a good point. He should not give way to interventions that imply that my Department or the Department of Social Security is in any position to answer the questions posed by the new clause.

Mr. Brown: I am grateful to my right hon. and learned Friend. I share his view that there is an element of confusion within the new clause. There is an element of a blank cheque in it. I should be the first to acknowledge, as the tone of interventions from a sedentary position suggest, that there may well be within the arena of private nursing homes those who are unscrupulous. It is those very unscrupulous owners of old-age pensioners' private homes whom the new clause will aid and comfort. If we want to introduce some decent common standards——

Mr. Robin Cook: Since the hon. Gentleman is making a speech that hon. Members can use as a clothes-peg on which to hang our queries, let me put it to the Secretary of State through the hon. Gentleman that he is fearful that the new clause will make it difficult for the local adjudication officers to establish what is reasonable or unreasonable. But it is admitted that every local authority will have to establish that for its area under the new arrangements, so what is to prevent the Secretary of State for Social Security and his local officers at least meeting what the local authorities define as reasonable?

Mr. Brown: I would not envy any Department of Health or Department of Social Security officer in the task that is being suggested by the hon. Gentleman. I simply see a black hole or a bottomless pit that would ultimately prevent value for money being obtained for the taxpayer or the patient in private rented homes.

Mr. Frank Field: rose——

Mr. Jerry Hayes: rose——

Mr. Brown: I have given way generously to hon. Members on both sides of the House and I shall not give way any more because many hon. Members wish to speak.
Notwithstanding the assurances that have been given, the new clause creates a black hole. Much taxpayers' money will be wasted and that will not ultimately benefit residents in private homes. As has been acknowledged, some unscrupulous people run such homes and they will be the first to take advantage of the loopholes in the new clause.

Mrs. Mahon: I feel somewhat alarmed. I expected that tonight we might get all-party support for the new clause, because it is a very good clause. We are talking about large numbers of increasingly frail, elderly people. I should like the hon. Member for Brigg and Cleethorpes (Mr. Brown) or some of his hon. Friends who will be opposing the new clause to tell us what is to happen to these elderly, often very sick, people. What policy will the Government put forward to take care of them?
We referred in Committee—and I do not say this in any flippant sense but because the hon. Member for Maidstone (Miss Widdecombe) and others mentioned it—to the Florence Smith gap that applies to every constituency in the land, and increasing numbers slot into it.
I have just looked at one or two statistics. In west Yorkshire, the average gap for a normal residential care home for the over-65s—not the very elderly—is £24·19. The gap for a nursing home is £19·59. That is the average, and I know that it is much higher in other areas. A constituent came to my surgery whose mother was in an ordinary residential home for elderly people. She was caught in this gap. The proprietor was not the decent kind of person that we would all wish to see in charge of such


homes but was quite unscrupulous. When my constituent, who was the only daughter, went to see her mother, she was locked out because she had said that she could not meet the difference in cost. Eventually she had to be moved. The daughter was subjected not only to the worry of finding somewhere cheaper for her mother but also to harassment by the proprietor. I suggest that such treatment will increase, and that there will be evictions.
What will the Minister do about these elderly people, because proprietors will not go on funding the gap? If we do not get evictions, will we experience the other kind of home that we have all heard about? Will we move back to the 10-bedroom situation, where neither the residents nor the people who see them in the home get any satisfaction?
I want to concentrate briefly on the Government's response to the problem so far. I hope that it will be different tonight. I am an eternal optimist.
The Government's response in Committee was to accept that there are problems. It was said in Committee that there were many bleeding hearts among Government Members, and that is true; there was a lot of sympathy about these problems. The Government described the existing system as being not satisfactory and then proceeded to ignore it. If the hon. Member for Brigg and Cleethorpes is anything to go by—and he has taken the Government line—they intend to carry on ignoring the situation. Even worse, Social Security Ministers suggest that people who are unable to meet their fees should turn to the National Health Service. There will simply not be the beds available.
As my hon. Friend the Member for Birkenhead (Mr. Field) said, we tried to get rid of care in the geriatric hospitals because we thought that care in the community was better. Is it seriously suggested that we should go back to the philosophy of the very long stay bed? I hope not. I do not want to see any more geriatric beds closed down; the British Geriatric Society says that that process has gone much too far and that we need more beds for geriatric patients, either long or short stay. To suggest that as an alternative, as Social Security Ministers have, is to fly in the face of the philosophy that we are all supposed to support.
Apart from anything else, there will not be any beds available. In fact, my own district health authority, because of the cuts imposed upon it as the cash allocated to it is not sufficient, is faced with the necessity of closing beds across the whole spectrum of disciplines, and one of the options is to take another 15 geriatric beds out of service. I think that that will become the norm.
I return to the major question that Ministers must answer tonight. They must tell us what they intend to do with the large numbers of elderly people who will be very anxious indeed, the ones who are still mentally able to grasp what is happening. As for the others, their relatives and the people who care for them will be desperately anxious. The Minister must tell us tonight, if he will not support this new clause, exactly what message he has for the thousands and thousands of Florence Smiths. There is all-party support for this new clause, and I hope that the Minister will not let us down.

Sir Dudley Smith: For some strange reason, Leamington Spa, which I represent, seems to be the mecca for old people. I believe that I have more residential homes

in my constituency than even Bournemouth, and even more perhaps than my hon. Friend the Member for Brighton, Kemptown (Mr. Bowden). I suppose that it is because we are in the heart of England, but anyway the numbers have increased greatly in recent years.
I agree with every speech made in this debate so far, with the exception of that made by my hon. Friend the Member for Brigg and Cleethorpes (Mr. Brown). I congratulate the hon. Member for Livingston (Mr. Cook) on his moderation on this occasion, and the case that has been predicated is unassailable. I know that there are considerable difficulties in finding the right form of words to get this problem tackled by the Department of Social Security, but I have absolutely no doubt that it must be tackled. This is a modern phenomenon caused by the fact that people are living longer. As we approach the next century it will become a critical matter and one which will have to be tackled whichever party is in power.
All of us who represent areas in which there are elderly people know only too well the sad and sorry stories of aged people, many of them incontinent and perhaps slightly deranged, who live on for 10 or even 20 years. Many of them have savings when they first go into a home, but gradually their savings dwindle because they have to pay for the growing gap between their income support and the cost charged by the homes.
I have seen many cases of families faced with an enormous moral dilema: should they try to help their mother or father to sustain what good quality of life there is in a residential home, or should they give up? These people are often of very modest means and may well be in early middle life, with young children. As every hon. Member knows, it is a very expensive time for families. Or they may be getting on themselves and perhaps reaching pensionable age, at which time every penny of their own savings will count for their own retirement. Are they to divest themselves of all their savings to help a mother or father, only to find that they finish up in a similar situation?
Therefore, this problem demands a very careful look by the Department of Social Security. Otherwise we shall end up, as I think the hon. Member for Birkenhead intimated, with large numbers of geriatric wards which will be very unpleasant compared with the residential homes which we have today and the numbers of which have expanded in recent years. Surely we cannot as a society face such a situation. We cannot allow old people to suffer the great indignity of being kicked out and moved around until a billet can be found for them. That would not be tolerated, and it would put an extra strain on the hospital system.
We must work out something far better than we have at present. I support the idea that we must be able to get the income support to cover the vast majority of the fees which are charged. At the same time we have to evolve a system whereby the homes concerned charge a reasonable sum for the people staying there. We must curb exploitation and sustain those who are managing, sometimes at a disadvantage to themselves, because they are able to cut corners. They are conscious that they need to support their inmates of whom they are quite fond; for them it is not just a commercial proposition.
I hope that the Minister will give us some assurance, because we shall not be able to get the new clause carried—[HON. MEMBERS: "Why not?"' I am being realistic. We want an assurance that the Government have taken note of the concern of hon. Members on both sides of the


House. I hope that he can satisfy us that the safety and well-being of thousands of old people will be safeguarded by the Administration, because it is a growing problem.

Mr. David Hinchliffe: I find it difficult to be as charitable about the Government's record as some of my hon. Friends, including my hon. Friend the Member for Birkenhead (Mr. Field), whose work in the Select Committee on Social Services I respect very much. I also find it difficult to accept what I can only describe as the bleating from the Government side. The Government are directly responsible for the shambles because of the policies that they have pursued over the last 10 years. They need to be reminded of that.
The Government have failed adequately to fund alternatives to institutional care. They have failed to take account of the demographic trends that have led to a huge increase in the number of people over the age of 85. They have cut back on the resourcing of domiciliary care, which is the alternative to institutional provision. At local authority level they have slashed the rate support grant which has had a direct impact on the provision of home helps, meals on wheels and other preventive services. They have also slashed Health Service preventive spending.
I give as an example a case with which the Secretary of State for Social Services is familiar. Recently he took part in a Yorkshire Television programme which featured the case of a constituent of mine, Mike Frobisher. That man is in care now, directly as a result of the fact that health services in Wakefield have been cut by the Government. Twice a week someone came along to help him bath; that was cut to once a week. He was affected in many other ways. Respite care in the local hospital was reduced. Finally, his wife collapsed. As the Secretary of State is aware, Mr. Frobisher is now in a home where he has to manage on 5p per week. That is all that is left for him to live on when everything else is taken into account. He does not have any spending money apart from that.
Alongside the cuts there has been an explosion in free market care which has been generated deliberately by a Government committed to market forces. The result is that we have hundreds of thousands of cases such as that of Florence Smith. The floating of open-ended income support arrangements has led to an increase in private residential care. There has been talk of blank cheques, but we have had those already. That is why there has been a huge explosion in private residential care that is not appropriate to the vast numbers of elderly and disabled people. A total of £5 billion a year is involved. It is big business now. Some people are making vast amounts of money in the private sector out of elderly, dependent people.
What concerns me most is the way in which the Government have created an institutional climate. There is an institutional vision of what is needed for old people. I do not believe that institutional care is the answer for elderly and handicapped people. There are alternatives, but the Government have slashed them and have forced people to enter institutional care, which is completely inappropriate.
The problems that people face in the community are horrendous. In many instances their problems are only beginning when they enter care because they cannot meet the fees. In Committee the Government said that existing

residents will have a preserved right to income support. That is fine, but what about the future of non-assessed residents who end up in institutional care on the basis of their capital resources, who spend those resources and have to apply for income support? The Government have failed to consider that category. I understand that they may be covered by upratings in income support, inadequate as they are.
The Association of Metropolitan Authorities estimates on the basis of DSS figures that there is a £40 a week gap in residential care payments and about £60 a week in nursing home payments. What happens to people when they cannot pay the fees? In a recent report the Select Committee on Social Services said that many elderly persons will face eviction if the Government's policies are implemented as they stand. When I moved an amendment in Committee on security of tenure, contracts for residents and the prevention of eviction, it was resisted by the Government. So the Government are prepared to accept that because of the free market a proprietor may say, "I am sorry; it is hard lines that you cannot meet what we are charging. You will have to leave. Get on your bike. We are not prepared to continue caring for you."
What are the options for such people when they cannot meet the fees? We all have such people in our constituencies. In most instances it is a matter of begging or borrowing. They may ask voluntary organisations for assistance. Many people are assisted by voluntary organisations which are in great difficulty because of the number of people whom they have to fund. Many elderly people are forced to go cap in hand to relations to ask for a supplement of £20 or £30 a week. That is not acceptable.
When I asked the Minister for Social Security about the problem in November he could see nothing offensive in relatives helping those in homes with fees. I find it offensive that people have to go out to earn money to supplement payments for relatives. That is simply not on, particularly when the elderly people have paid national insurance and taxes all their lives. Some of them are 90, 95 or even 100.
We should also take into account the feelings of the elderly and handicapped people who have to beg and borrow from relatives to supplement their income. When they have saved up all their lives, how do they feel when they find they can no longer look after themselves financially? It is appalling that the Government are prepared to allow them to seek help from relatives. Many elderly people still have pride. We should respect it. We should say that it is inappropriate for them to be subsidised by their relatives.
At my previous surgery a man was desperately concerned about his inability to meet the fees for his adult son in a private home. He and his wife were worried that the fees were increasing beyond what they could pay. His wife was seriously considering volunteering to work in the home to offset the increase in fees. These people are not young. They have a handicapped lad of about 29. They have gone through hard times. Even though their son is in care, they still have to worry about meeting the fees.
If people cannot afford the fees, they have the choice of going down market. They can go into a home which does not have sherry on offer. Surely the offer of a glass of sherry should not figure in the evaluation of care in a home. After I had spoken at a meeting last Friday night, a lady came up to me and said, "I am in the private sector. Come to my home. We have bone china." She told me that the residents got a drink of whisky, I think it was, before


they went to bed. That was her advertisement of the care in her home. I suspect that description of care. That is not the care that I would want if I ended up in a residential home. That is not a way of evaluating the quality of care.
Age Concern has expressed anxiety about how the income support problem is forcing down standards in many homes. There are lower levels of care and people are having to move from single rooms to shared rooms simply because the resources are not available.

Mr. Peter Griffiths: Does the hon. Gentleman agree that one of the least acceptable solutions to the problem that he has described is that residents who cannot meet the costs in registered homes will be moved into unregistered homes with three or fewer guests where there is no inspection of the services on offer?

Mr. Hinchliffe: I hope that Conservative Members were listening to that very valid point. The Opposition were concerned about that, which is why we pressed in Committee for the registration of smaller homes. What the hon. Gentleman described is happening now. I hope that the hon. Member for Portsmouth, North (Mr. Griffiths) will be in the Chamber later when we discuss the new clauses on the registration of smaller homes. I am sure that Conservative Members as well as Opposition Members are concerned about that.
Many of the people who can no longer pay private sector fees are now forced to look to local authorities to provide residential care. Clause 37 excludes local authority homes from the new funding arrangements and places them at a clear financial disadvantage. Local authorities are getting rid of direct provision because they can no longer afford to offer the provision by part III accommodation. As well as people being passed on to part III accommodation, that accommodation at local level is now disappearing.
The Government must address the problems that have been raised by hon. Members on both sides of the Chamber. New clause 1 attempts to deal with the consequences of what can be described only as the Government's free market experiment with care. If the Government see fit to leave the provision of welfare in the hands of market forces—as they clearly have done over the past 10 years—if they are not willing to develop clear alternatives to institutional care in terms of prevention and keeping people out of care, and if they believe that the institutional model is the only major response that society can give to the needs of handicapped and disabled people, the least that they can do is ensure that when people end up in institutional care or are forced into it because of the lack of alternatives, those people can live their lives in financial security and not worry daily and weekly where their fees will come from.

Mr. Andrew Rowe (Mid-Kent): I will be astonished if the Government accept the new clause. With the best will in the world, there is no way of preventing charges rising universally to meet income support levels. It is perfectly clear that the supporters of the new clause have no desire to write a blank cheque. However, it will be impossible to avoid that consequence. If it happens, it will shrink other budgets which will be needed to care for the vulnerable. In

the end, the effects will filter through the system so that the new community care system, which we are so anxious to see succeed, will be put at risk.
It would, however, be foolish and wrong to suggest that there is no problem. Therefore, what are we going to do about it? There are some strengths in the present position. The number of people in the category about which we are concerned is finite and known. After the Bill is passed there will be no increase in that number. The new customers under the new system will be covered by a contract that will not allow public services to renege on their responsibility to those people. We are concerned tonight with a number of people, many of whom did not have a serious contract except in so far as if they paid the bill, or it was paid, they would receive care. I can understand and applaud the desire of Health Ministers not to overload social service departments, which will already be heavily burdened, by giving them responsibility for that particular group of people.
In parenthesis, I must state that homes are at great danger at the moment. We must consider the stock of places that exist at the moment. It is all very well for the hon. Member for Wakefield (Mr. Hinchliffe) to refer to the private sector for making vast amounts of money. With the exception of a tiny handful of fortunate, skilled or highly selective proprietors, the exact reverse is the case. The hon. Member for Livingston (Mr. Cook) and others have said that many homes are vulnerable. As my hon. Friend the Member for Maidstone (Miss Widdecombe) stressed, those homes have large debts to service. Proprietors have told me with great force that they a re very worried about how long the new local authority assessment procedures take to supply them with replacement customers if their customers die or move out of their homes. There may be too big a gap to fund and proprietors will be vulnerable.

Mr. Hinchliffe: With regard to the hon. Gentleman's point about the profitability of the private sector not being very high, can he explain why, if that is the case, a great number of companies of national renown are moving into the private care sector? Such companies include Stakis plc, the amusement arcade business Kunick plc, Buckingham the international disco and leisure complex company, Vaux plc, Boddington's brewery and Ladbrokes. Are those companies moving into the sector because there are no profits to be made?

Mr. Rowe: It would be foolish to imagine that there a re no profits to be made. However, I believe that where profits are to be made, they can be made only in most cases by companies large enough to weather the difficult periods as well as the relatively easy periods.
The hon. Gentleman is aware that many small and medium-sized homes have been started by people from the highest possible motives. Homes have been started by people who could not find appropriate care for their children so they decided to set up a home to cope with their children and with others as well. The impression that is sometimes given by Opposition Members that we are talking about a sector into which people move only because they can make profits by exploiting the vulnerable is wrong.

Mr. Frank Field: Will the hon. Gentleman answer his own question: what should the Government do?

Mr. Rowe: I am sorry. I was distracted slightly by interventions. I had intended to discuss that now.
Central to any solution to the avowed problem must be a predictable budget which can be foreseeen and provided for. That is why I am completely against any suggestion of a blank cheque.

Mr. John Battle: Does the hon. Gentleman accept that the Government have already given a blank cheque in housing to the private landlords because they are committed to paying housing benefit at whatever level? If that is the case in housing, why can there not be funding in care as well?

Mr. Rowe: I do not want to pursue that avenue too far. The hon. Gentleman should be careful about suggesting to Treasury Ministers that there are blank cheques anywhere.
Given that there has to be a discernible, predictable and finite budget to deal with what is, after all, a predictable and finite number of people, Ministers might profitably consider two elements. First, perhaps there could be a regional differentiation in the amount of income support that is available for this purpose. That is a crude measure, but it is better than giving a United Kingdomwide level of support because there are discernible differences in different parts of the country. Like my hon. Friend the Member for Lancaster (Dame E. Kellett-Bowman), I am not suggesting that one can make a crude division between north and south or east and west, but it is possible to make a division between areas where prices are relatively low and areas where they are far higher, as in my area. Nor is it unreasonable to consider the debt burden relating to the age and capitalisation of such a home.
When it comes to assessing individuals, the Government have a precedent to hand. The independent living fund has been a substantial success at making a whole range of difficult and sensitive decisions. Perhaps providing an organisation at arm's length with a finite budget and saying, "You take over the difficult issue of assessing people for the additional support", may be a help.
Finally, the new clause as drafted is manifestly flawed because it cannot come into effect until next year which, for many of the people with whom we are concerned, will be too late. Therefore, although I am opposed to the new clause, I advise Ministers that they must come forward with some concrete suggestions about how we can meet the needs of the most vulnerable people in our community.

Mr. Alfred Morris: The speech made by the hon. Member for Maidstone (Miss Widdecombe) was a most powerful and, I hope in its effect, an influential contribution to this important debate. I am glad to note her return to the Chamber.
Much of my parliamentary life has been spent trying, both as a private Member and as a Minister, to improve residential and community care for frail elderly and disabled people. If we are to ensure humane standards the essential principle is that, in every case of need, the right care should be available in the right place and at the right time. Otherwise people in special need are left in despair, as happens in so many cases now when residential care fees cannot be met. The relatives share that despair.
After a decade in which the financing of residential care was shifted, in an unplanned and officially unpredicted way, on to the social security budget, the Government are returning in this Bill to the old system of local authority

sponsorship. Although there were always tough negotiations between local authorities and voluntary organisations, the old system is now acknowledged to have been the best method of ensuring both value for money and special provision for those with special needs.
The new clause seeks to protect those who are trapped in the system that is now being discarded, which has proved to be a Procrustean bed. In the original format, which was introduced by the right hon. Member for Brent, North (Sir R. Boyson), payments were practically open-ended and costs expanded rapidly. A series of panic measures were introduced to cut the costs, but national yardsticks have proved just as insensitive as the old Greek bandit who either stretched his guests or cut off their limbs to fit the accommodation provided.
The new clause is concerned with those whom our modern Procrustes in the Department of Social Security has maimed. Almost half the residents on income support do not have their full costs met, as my hon. Friend the Member for Birkenhead (Mr. Field) said in oral questions on 5 March. In response to my subsequent question, from the Opposition Front Bench, asking the Minister at least to
ensure that income support payments keep pace with the charges agreed by local authorities for new residents
the right hon. Member for Chelsea (Mr. Scott) appeared to misunderstand the question, which he failed to answer, and he referred to extra resources for community care. No extra resources are being provided for existing residents. Moreover, in Committee Ministers resisted the imposition of any duty on local authorities to assess current residents for a possible return to care in the community.
Later amendments are concerned with rights to residential community care, where it is needed and desired. In reply to my question on 5 March, the right hon. Member for Chelsea referred to the
perverse incentive for people to go into residential care"—[Official Report, 5 March 1990; Vol. 168, c.574.]
But the Government seem determined to swing the pendulum too far the other way, in that there is now often a perverse ministerial insistence on sweeping under the carpet the needs of people for whom such care is a vital necessity.
7.45 pm
Very old and frail people, who have been in residential care for several years and who have grown accustomed to the idea that this will be their last home, need the assurance that the Government will continue to meet their costs until the day they die. The attitude of Ministers is causing extreme distress, not only to residents, but to their relatives, who are often poor and disabled themselves, and who are approached to make up the difference between fees and benefits. That piles handicap upon handicap for the very needful people this new clause seeks to help.
The record shows that I was one of those who repeatedly warned the Government where the policy that they are now discarding would lead. In the spirit of the speech made by my hon. Friend the Member for Livingston (Mr. Cook), however, I am not concerned tonight to say "I told you so." Give or take the speech made by the hon. Member for Brigg and Cleethorpes (Mr. Brown), there has been scant controversy in the debate.
The new clause is eminently fair. It has strong all-party backing and the House should accept it. I sense deep and widespread unease on both sides of the House about the


problem that the new clause seeks to resolve. The only proper way to give effective expression to that unease is in the Aye Lobby tonight.

Mr. Bill Walker: I shall be brief, because many other hon. Members still want to speak. The Government would be unwise to accept the new clause as it stands. That is not to say that there are not problems, because it would be foolish to pretend otherwise. There may well be regional variations and differences that need to be considered positively, sympathetically and constructively, but that does not mean that we should put on the statute book legislation that may have an open-ended commitment.
When my right hon. Friend the Secretary of State replies to the debate, it would be interesting if he could give some idea of the likely envisaged costs of implementing the new clause, if that has been worked out. We are usually told that we should be prepared to understand the commitment that we are entering into. Being a canny Scot, I do not want us to enter into open-ended commitments for which the taxpayers will be required to pick up the tab. As I have said, I believe that we would be wise to look at the problem, bearing in mind the regional variations that may exist.
In that context, I must declare an interest because I have many such homes in my constituency. Obviously, therefore, lots of patients are my constituents. Many such homes have been opened recently and, as far as I can tell from the visits that I have made—and I still have quite a number to visit after already visiting a substantial number—the patients appear, in the main, to be well looked after.
One must acknowledge that problems exist in some areas. It would be foolish to pretend otherwise. Another factor that must be considered is the variation in input costs. One thing that has struck me on my visits to different homes is that some homes are more expensive to run than others. The people who pay are those who pay for the patient, or inmate, depending on what one wishes to call them, but in any case those who are staying in the home and are not part of the team that operates the unit. People pay through taxpayer funding, whether partially or totally. The House and the Government must look carefully at the matter and deal with it positively and constructively. I am not prepared to vote for the new clause as it is drafted.

Mrs. Audrey Wise: With one exception, everyone acknowledges that there is a problem. I even saw the Secretary of State for Social Security nod when his hon. Friend the Member for Tayside, North (Mr. Walker) said that there was a problem. So at least we have reached first base on the matter.
Some possible solutions which have asserted themselves among some Conservative Members would not be acceptable. The hon. Member for Mid-Kent (Mr. Rowe) acknowledged that there are problems. He seemed to finish up by suggesting that in some areas—such as his—more money was required. Any suggestion that a solution could be found by providing more money for the south-east would not find wide favour.
The hon. Gentleman also suggested that we could take some comfort from the fact that the problem is finite and is not growing. But it will grow for a little while. I understand that the present system will operate until April 1991. All those entering homes before April 1991 will be in the position that we describe. The current number of people claiming income support and living in residential

homes is 176,000, a considerable number. They do not all have relatives, but some do. If we add their relatives, that makes a large number of people who are exercised by and worried about this problem.
Clearly cost is a pertinent question. Why are the Government so coy about it? They must be fixing their special income support level by reference to some calculation of costs, unless they simply pick it out with a pin. They must have some method of deciding how much they will give. Do they say, "We shall give 60 per cent. of the average", or "We shall give 90 per cent. of the average"? What do they regard as the average? What do they regard as the range? They are surprisingly coy on the matter.
In a parliamentary answer on 24 January, the Department said:
When taking decisions on increases, we took account of a wide range of information on costs and charges in homes. This primarily came from the Department's own local office returns, independent research and detailed representations from outside bodies,"—[Official Report, 24 January 1990; Vol. 165, c. 1029.]
Outside bodies which have an opinion on and knowledge of the matter all say that the Government have got their figures wrong.
The Government should look with kindness on the Select Committee's recommendation to
immediately commission a rapid independent investigation of the costs of residential care and nursing homes. The results of this research should be published.
That is the key point. The Government should have the research done and should publish the results. Then we can all see whether the true picture is one of profiteering, we shall have a much better idea who the profiteers are, and we shall see the extent of the burden being tackled in examples such as that given by my hon. Friend the Member for Livingston (Mr. Cook). He referred to the problems faced by a group of Roman Catholic nuns in running their residential home. If independent research were carried out and published, the whole discussion would be on a much firmer footing.
No Opposition Member wants to make life easy for profiteers, in particular those who profit from the needs of the elderly. It is astonishing to us that some Conservative Members invoke profiteering as a reason for leaving elderly people without sufficient resources to meet bills which may well be legitimate. If people are profiteering, there are probably other things wrong with the home. Clearly such people are in the business for the wrong reasons. There should be a means of tackling that problem. Perhaps that could be explored later when the House considers matters of quality.
In view of the representations made by the National Council for Voluntary Organisations and others, I am not willing to say that all homes overcharge. I do not believe that that is the case, nor do the Government make that case. They do not make any case on costs. They simply produce a figure and then upgrade it by £10 without publishing any groundwork or justification for it.
These are serious matters and they will have serious results. The Minister for Social Security believes that it is in order for relatives and charities to be a central part of funding care for the elderly. However, that has not been the intention of the House. Relatives may not be able to afford to contribute. There may be no relatives. Surely charities raise money for purposes other than to take on


the burdens which should rightly belong to the state and to us all. It is unacceptable to say, "Let relatives and charities pay."
If, despite their best efforts, an elderly person's relatives cannot pay, the result may be that he or she cannot have residential care even if it is the most appropriate type of care. Community care may become forced community care by relatives who cannot afford the extra fees to make up the income support. Relatives will be left to do the caring without proper back-up from the community.
This is not a proper community care Bill. I do not wish to make too many waves in this all-party atmosphere, but to leave five days between the publication of a White Paper on community care and the tagging of clauses on to the Bill is fraught with dangers. I cannot understand why, after 15 months of blank silence between the publication of the Griffiths report and the Government's response, the Government went to the other, equally undesirable extreme of acting with precipitate haste and producing something which has not been properly thought out.
There will be other anomalies with regard to relatives, as the Select Committee pointed out. The relatives of people entering residential care after April 1991 will suddenly face fewer burdens. Suddenly it will be all right for them to say, "We cannot afford it." The Government will tell local authorities that it is their job to pay for care. Is that the difference? After April 1991 the local authorities will have the responsibility. Do the Government not mind giving local authorities extra tasks, however difficult they claim those tasks to be?
I am sure that you are aware, Madam Deputy Speaker, although Tory Members may not be, that the shortfall which is affecting individuals and their relatives will also affect local authorities. We shall have an opportunity under a later clause to explore the dangers and problems that will arise. At present we are looking at the effect of the shortfall on the unfortunate individuals who are termed "protected". One hon. Member, I am not sure on which side of the House, called them "excluded", and that is a much truer description.
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The possibilities range from eviction. The Select Committee on Social Services does not go in for extravagant language, yet we contemplate elderly people, some of whom are frail, facing eviction. They will not be protected against it.

Mr. Frank Field: When at the beginning of her speech my hon. Friend gave the figures, I calculated them on a constituency basis. She is right to say that not everyone will be evicted, but everyone risks eviction. There are about 160 residents per constituency in that category. In my constituency, that means two full streets. If we talked about two full streets of residents in every constituency risking eviction, the atmosphere of this debate would be even more tense than it is.

Mrs. Wise: I thank my hon. Friend for that apt picture. In case anybody thinks that we are trying to overstate the case, I point out that, according to the Government, not all the 176,000 are unable to meet the costs from their own resources. The Government say that a majority can meet the costs from their resources. That majority turns out to be 58 per cent. If, instead of my hon. Friend's two whole

streets, I was terribly generous and suggested one whole street not just of people but of frail, elderly people who risked eviction, even on that modest evaluation, we and they still face a worrying situation.

Mr. Michael Jack: The hon. Lady's remarks may be a little unnecessarily harsh, particularly on those who run private rest homes. I know from constituency experience of many elderly people whose condition has deteriorated and who need much better nursing care than the rest home can provide, yet the owners of the homes feel a deep obligation to them. They are caring people who look after their elderly residents. Although they need more money to do so, they keep them on the same premises and do not throw them on to the streets.

Mrs. Wise: The hon. Gentleman has misunderstood my point completely. I am not blaming the owners of the homes. From the beginning I have said that those who profiteer and are unsuitable should be dealt with in some other way. My concern is with the wide range of homes such as those described by my hon. Friend the Member for Livingston—for example, the homes of the Roman Catholic nuns. I fully agree with the hon. Gentleman that the owners may wish to provide care, but, however keen they are, they cannot do it on fresh air. Presumably they must pay wages and buy food, and many other costs are involved. I am not discussing the intentions of the owners or those who run these homes. For the purposes of this debate I am prepared to accept that they are all splendid. The fact is that they cannot run a home without money.
In a way the hon. Gentleman has reinforced my point, although he did not intend to do so. He has added a whole new category of desperately worried people—those who try honestly, legitimately and properly to care for elderly people and provide them with a home. Whether they are in the private sector or the voluntary sector, they cannot do so with the sort of shortfall which has been described by the National Council for Voluntary Organisations and which is regularly described by our constituents. It is not often that the hon. Member for Maidstone (Miss Widdecombe) and I are found on the same side, but, whether we like it or not, the inescapable facts of this issue drive us together. It is a remarkable cross-party experience.

Ms. Dawn Primarolo: The Government are taking us towards this disaster deliberately, and they know it. My hon. Friend mentioned a figure of 168,000 people. In a letter to me on 8 January the Under-Secretary of State for Social Security gave me the Government figure of 176,000 people in residential care or nursing homes claiming benefit. Therefore, although the Government expect the number of people who need income support to continue to grow, they deny them help.

Mrs. Wise: I thank my hon. Friend for that intervention. Indeed, the interventions have been extremely helpful to me.
The universality of our experience across different types of area is unusual. I can describe it in Preston where, generally speaking, people do not have much spare money with which to pay the shortfall on behalf of their elderly relatives, however much they desire to do so. We have heard of it in Kent where costs are higher, so although people may have more resources, they find it proportionately difficult. The Secretary of State for Social


Security needs to do more than simply acknowledge the problem. He should accept this solution on offer to him or, failing that, outline an equally comprehensive and satisfactory one.
There are other likely consequences. Homes, whether for good or bad reasons, may, in an attempt to cover the shortfall, pay wages to staff which are too low. That would have bad effects not only on the staff but on the people for whom they care. It may affect the quality of staff whom they can recruit. That is undesirable. We want our elderly people to be looked after by people who are properly paid.

Mr. Hinchliffe: My hon. Friend makes an important point about staffing arrangements. Last week I attended a meeting of the all-party personal social services committee when a representative from the British Association of Social Workers said that in Liverpool 16-year-old girls employed in old people's homes were changing catheters of men and women alike. They were untrained and were being paid about £1 an hour. I am sure that my hon. Friend will share my anxiety about what is going on in the private sector.

Mrs. Wise: I think that anxiety is too mild a word. The right word is horror. If that is the road down which people are travelling, it is a disgrace—a blot on the House—because the House bears the final responsibility for ensuring that there are adequate resources. When we have ensured that, we can follow it up by ensuring that there is adequate quality of care resulting from those resources. We cannot say care properly but do it without the proper resources; that is impossible.
As has been graphically and dreadfully illustrated by my hon. Friend the Member for Wakefield (Mr. Hinchliffe), there will be skimping and the use of unsuitable and unqualified staff—probably overworked staff as well. Overworked and underpaid is not a good recipe for proper care.

Sir Anthony Grant: If they can get the staff.

Mrs. Wise: That is a valuable point. Of course not everybody would be willing to undertake care in such an unsuitable way, and not everybody would be willing to be driven into jobs for which they were unsuited, despite the best efforts of the Conservative party.

Mr. Allan Rogers: The hon. Member for Cambridgeshire, South-West (Sir A. Grant) asked whether one would he able to get people to work in such situations. There is no difficulty in getting people to work in the many regions of the country which still have high unemployment and where people—especially women—are forced into low-paid jobs because there are no other jobs available for them.

Sir Anthony Grant: rose——

Madam Deputy Speaker (Miss Betty Boothroyd): Order.

Mrs. Wise: I had better acknowledge that intervention and then I shall give way to the hon. Member for Cambridgeshire, South-West (Sir A. Grant).

Sir Anthony Grant: In some areas—mine in particular—nursing homes have enormous difficulties in getting staff

to help those poor old people. Much as they would like to do so, they cannot go down to Wales to recruit them. It is very sad.

Mrs. Wise: That is another illustration of the universality of the experience. Although the emphasis is different in different areas, there is a problem. I think we are on common ground and without resources it is impossible to get properly trained staff who will give the proper quality of care. I do not want people who run residential and nursing homes to have the excuse of lack of resources. I want to be able to come down on them like a ton of bricks if their care is unsuitable, but I fear that the Government are putting us in a false position.
As hon. Members have pointed out, there will be two tiers of residential care. In fact, it seems that that already exists, as hon. Members have pointed out. I do not want people to be accused of dumping elderly relatives if they enter a residential home with that accusation being true because those homes are dumps. People will face bills that they cannot pay or tasks that they cannot undertake in their own home or they will have to dump relatives, and that is an intolerable choice.
Surely we can manage to get some cross-party support on the matter. I fear that some Conservative Members are shielding themselves from the arguments by not coming into the Chamber. I hope that those Conservative Members who are acquainted with the arguments, and who are here tonight, will pass on the message.
This issue could give the Government more problems. I shall give the Government a little advice, because if this works out well and our suggestions are accepted the Government will get the credit. The Government usually get the credit in the end for any extra payments or extra care that come from the state. Therefore, given the general context in which the Government are operating, I should have thought that, in self-defence, the Secretary of State for Social Security would positively welcome the new clause.
If he does not welcome it, and if it is rejected, I am driven to the conclusion that this is due to the extra burdens they intend to force on to local authorities. If more money is made available for the individual to meet the costs, more money will also have to be made available for local authorities to meet the costs. If the new clause is rejected against all the excellent advice given to the Secretary of State by his hon. Friends, I fear that that will be the reason, and it is a disreputable reason.

Sir George Young: My hon. Friend the Member for Maidstone (Miss Widdecombe) spoke for me and I suspect for a large number of my hon. Friends when she made a moving speech describing the problems that face Florence Smith, and the many others throughout the country like her. I am always amazed at the sacrifices that so many families make to keep an elderly relative in their home. Those sacrifices go way beyond what might be legitimately expected.
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I welcome two decisions that the Government have taken in this broad area. First, they are quite right to have a cut-off point on 1 April next year, and to say to local authorities that the new Griffiths regime for care in the community should apply to new residents and claimants only from 1 April. That strategic decision was justified


because there was no way in which local authorities could have coped with existing residents if they were to get the new structure going.
Secondly, the Government were right to prevent local authorities from topping up existing residents, because if they had done so it would have been a drain on the inevitably limited resources for getting the new care in the community package going.
We are all agreed that there is a residual problem of resourcing residents who are "protected" and who will continue to look to the DSS for income support to pay their bills. There will be new claimants, because anyone in a home at the moment who is not claiming because he has his own resources but who runs out of resources in the future will have to look to the existing DSS regime for help and not to the local authorities. It is not the case that the number of claimants is finite. There can and will be new claimants as existing residents run out of resources.
One issue has not been adequately raised—the pressure on housing associations, charities and organisations that run homes. Servite House in Ealing is an example. It recently closed an excellent home in Ealing simply because it had to make such huge inroads that it could not afford into its own reserves to keep it going. Hon. Members who have met housing associations and other charities know of the pressure on their resources caused by the present regime. It is a matter not simply of people digging into their own pockets to keep the structure going, but of private and voluntary organisations digging into limited reserves to keep things going. There is a limit to how long that can go on.
Another issue that has not so far been mentioned is that next year there will be a transfer of resources, in regard to income support, from the DSS to the local authorities. Under the new regime local authorities can buy contracts with homes. That transfer of resources will be based on existing income support levels. If that is the basis of transfer, local authorities will get inadequate compensation with which to get the Griffiths regime going. It would be disastrous to under-resource the new structure—in which I have great confidence. It is not simply a matter of getting it right for people who are in homes at the moment. The figure that will be used will reflect how much of the resources—ring-fenced or otherwise—will be transferred to social service departments to get the new package going. I hope that we can avoid the risk.
There will be some difficulties with the solution advocated in new clause 1. I am not wild about adjudication officers going round to decide whether a tariff is right. Nor am I particularly enamoured of the regional variation solution put forward by my hon. Friend the Member for Mid-Kent (Mr. Rowe). The solution that I like has been touched on in the debate, and lies in part III of the Bill.
As from 1 April next year local authorities will be inviting all the organisations that we have been talking about to tender for contracts. When that happens, the organisations will have to put in a price. They will state the fee that they will charge if the local authority wants to continue to place people in a residential or nursing home. The local authority will either agree that that is a fair price and place a contract with them or it will reject it. That price could be used by the Department of Social Security to validate the payments that are made to those on income support. It is a price that the home believes to be fair; it is a price that it will have used in the bid that it made to the

local authority; it is a price that the local authority believes to be fair because it will have agreed it when it placed the contract. Given that it is satisfactory both to the home and to the local authority, I see no reason why my right hon. Friend's Department cannot say, "We shall uprate income support for residents in that home to the agreed level."
That would avoid the problem of having two classes of resident in one home: one resident on income support, who perhaps receives an inferior standard of service, and another resident who entered the home under a new contract that was negotiated by the local authority at a higher price and who is offered a higher standard of service. I feel that that problem will arise if we do not do something about it. It would be avoided if income support were uprated to the agreed contract price that had been negotiated between the local authority and the home.
If my right hon. Friend the Secretary of State were to say that he could not agree to new clause 1, for whatever reason, but that he was minded to go in the direction that I have outlined by validating prices that had been negotiated, I should be happy to vote against new clause 1.

Mrs. Rosie Barnes: I shall try to speak briefly; the argument was made—game, set and match—in the first three speeches. I pay credit to hon. Members on both sides of the House for sticking to the facts and making a convincing case.
We are talking about elderly people who, by definition, will die in the next few years. However, others will come along who need income support as their incomes decline. Much of the debate has focused on the blank cheque element of the proposals. We are talking about a finite number of people, but a dangerous blank cheque will be involved if we do nothing about them. Where will they go if, as we suspect, some are evicted from the homes in which they live? They will go into hospital. However, they will not go into geriatric beds, because there are not enough. They will go instead into acute beds. The National Health Service needs those beds. They are in heavy demand for all kinds of treatments.
Apart from the cost implications of elderly people occupying those beds for, perhaps, years, there is also a political implication in terms of waiting lists. Many hospitals could tackle their waiting list problem far more effectively if some of the beds that are now occupied by elderly people could be released. At the moment, however, there are no satisfactory alternative placements. If more of those beds are to be occupied on a long-term basis, the House ought to bear in mind the political implications of such a blank cheque.
We should also consider the implications for those whom we should subsidise if the new clause were accepted. Some hon. Members have suggested that we are offering a golden opportunity to those who wish to make a quick buck out of the elderly. A few may do that. However, I have read carefully the representations that were made to me by the voluntary bodies and I am not convinced that the majority of the homes involved would do that. The National Care Homes Association told the Select Committee that seven out of 132 nursing homes and one third of residential homes charged fees that were in line with social security levels but that two thirds of the homes for the elderly could not cover their costs by means of income supplement. The National Federation of Housing Associations said that income support levels had not kept


pace with the true cost of care. These are not the Rachmans or people who are making vast profits out of the elderly. They are trying to supply a genuine service at cost, but they find it increasingly difficult to achieve their objective.
The new clause would redress the imbalance. Reference has been made to avoiding exploitation by the appointment of an adjudicator. I listened with interest to the suggestion that there may be a better method of assessing what is the fair rate for a particular home. However, I should have to consider the implications for residents who may be in homes which do not have contracts with local authorities and which would fall foul of that suggestion.
After 1991, new residents will not have to contend with the problem. Their full fees will be covered. However, we are referring to about 100,000 most vulnerable people whose needs will not be met. They have to turn to local authorities, charities and their families to make up the shortfall. We are referring to the very elderly, many of whose relatives are also elderly. The point was brought home to me recently when I visited a geriatric ward and was introduced to a very elderly man and then to his daughter who occupied a bed in the same ward. Those who are well into their 80s or 90s have children who are between 60 and 70 years of age. All that they can be expected to do is to cope with their own problems and to make financial provision for their own future without having to take responsibility for their elderly relatives.
To do nothing is not an option. If continuity of care for these people is to be assured and if they are to have peace of mind, the new clause must be passed. It will provide security for the most vulnerable members of our society. Without such a change, the omens are gloomy. The National Council for Voluntary Organisations conducted a number of in-depth interviews with a variety of organisations that revealed some of the highly unsatisfactory measures that already have to be taken. They include the closure of homes in order to cover losses, or a policy change so that only those who are able to pay the fees are admitted—inevitably at the expense of those who are in the greatest financial need—inability to attract staff because of low wages, development plans deferred or scrapped, inability to carry out maintenance, refurbishment or the upgrading of buildings so that there is a more appropriate environment for residents, and a general reduction in the quality of life for residents.
It is abundantly clear that such cuts and measures, at a time when the number of elderly people in our midst is increasing and will continue to increase, are highly undesirable. I shall not detain the House any longer; other hon. Members are anxious to speak. The case for the new clause has been made convincingly.

Sir Anthony Grant: I, too, will be brief. Nearly all the arguments have already been deployed. Nearly all of them go against the Government, I regret to say, and in favour of the broad principle in the new clause. The hon. Member for Greenwich (Mrs. Barnes) summed it up admirably. I agree with nearly every word that she said.
I put my name to the new clause not because I am wedded to every single detail or because I think that it is a perfect piece of drafting. Drafting is never perfect. We have all been around long enough to know that if the principle can be accepted the Government will find a way to meet that principle. I was moved to put my name to the

new clause because of an experience in my constituency. It contains a number of excellent private nursing homes, and one of them highlights the problem. The Weald nursing home looks after a number of very elderly people whose elderly children come to see them. Those people a re admirably cared for by the proprietors who have dedicated their lives to the problem. They have provided them with a wonderful service. That home was expanding. Indeed, I opened an extension for it a few years ago.
The problem is quite simple: the elderly residents carne in on the basis of income support, but that support has not kept pace with inflation. There is now a shortfall, and these people are unable to obtain a top-up to rectify the situation. As a result, unfortunate elderly and worthy people are in danger of being moved out. However, because the proprietors are very compassionate they go to great lengths to avoid that. They move residents into other accommodation. They squeeze them in. They make economies here, there and everywhere, and in some cases almost subsidise residents. In this day and age, that cannot possibly be right. It cannot be right that people who have lived honourable lives should find themselves in such an undignified, worrying and anxious position.
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The new clause may be defective in some way, but I do not accept the "blank cheque" argument. Nobody wants a blank cheque to be provided. As I understand the situation, however—and I am open to correction—it will be possible to have restraint in the case of new residents. If that is the case, why on earth can it not be applied to existing residents? If there is a problem, I cannot conceive of its being beyond the wit of the Government, with all their resources, to find ways to ensure that solving it does not involve signing a blank cheque.
I hope that the Secretary of State will say that he realises that there is a problem. Perhaps he will say that, for some reason, the new clause would be ineffective. Perhaps he thinks that the suggestion of my hon. Friend the Member for Ealing, Acton (Sir G. Young) is a better one. In any case, he should tell the House that he will deal with the problem. Perhaps he could urge withdrawal of the new clause, on the clear understanding that the Government will produce something along the lines of this principle. I am bound to tell my right hon. Friend that, if that is not done, I will find myself in a great dilemma. I have been a loyal supporter of the Government for many years.

Mr. Campbell-Savours: Oh.

Sir Anthony Grant: It would not be the first time I had rebelled, nor would it be the last. I do not like to vote against the Government. I believe that, in this Bill, they are, in general, doing the right thing, but if I do not receive a reasonable assurance from my right hon. Friend I shall feel inclined to vote against them.
The Minister is a compassionate and sensible man. We often come across Ministers who are sensible but not compassionate, and Ministers who are compassionate but not sensible, but this Minister is both compassionate and sensible. I know that he will take on board, with all their weight, the arguments that have been put before him on behalf of very worthy, decent people, who have a right, in the twilight of their years, to live in reasonable peace and dignity, without anxiety.
If we do not get a reasonable response, what shall I do? I suppose I could go home—that would be one solution—or I could abstain. Instead, I will listen very carefully, and with an open mind, to what I hope will be a reasonable, compassionate and sensible response from my right hon. Friend.

Mr. McCartney: I am a member of the Select Committee that went into this matter on numerous occasions—since it was first brought to attention in 1987. What we are discussing tonight is a problem that has been building up for seven years. As a result of deliberate Government policy in 1983 to expand the private sector and to introduce market forces into the area of care of the elderly and of other specific groups, resources were unleashed in an unplanned way. That led to limits being set at local level for board and lodging, for residential care, and for nursing home care. In different areas the limits for residential care could vary between £51 and £215 per week, and for nursing homes between £80 and £290. In one financial year—1984—the effect was such that the Government tried to put limits on the activities of local social security offices. Indeed, by September 1984, they had restricted the ability of the Department to make decisions at local level. In those 12 months the Government unleashed forces with which, for the past seven years, they have been unable to cope. I refer both to the financial situation and to the unplanned and unstructured way in which the sector developed.
In 1985 that system was scrapped. Over the next two years the Select Committee on Social Services received evidence—first in a trickle, and then in an avalanche—about the growing gap between the cost being met by the Department and what a resident or his family had to pay from his own resources. During the same period local authority provision grew by 4 per cent. annually, whereas in the private sector the rate of growth was 350 per cent. More than 40 per cent. of all residents in board and lodging, residential care or nursing homes are in the private sector. At a time of such massive explosion, although there was an average of 4 per cent. growth in local authority provision, in many areas there was actually an absolute loss of provision, by way of homes being taken into the private sector or as a result of closure, or by reason of local authorities' joint arrangements with health authorities to operate exclusively in the private sector.
During that period I was a member of the Social Services Committee and of the planning committee. The avalanche of planning applications was such that special arrangements had to be set up between the social services committee and the planning authority to monitor the quality and nature of applications. At the same time, the social services department, with the health authority, set up an allocation system to deal with bed allocation. Consultants at Billinge hospital refused to accept frail elderly patients both from the private sector and from the local authority. There was a tit-for-tat arrangement, and I believe that it continues. If someone in part III or part IV local authority accommodation—even at that intensive nursing level—was incapable of being sustained by the local authority, the health authority would accept him back into its care if the local authority could accept

someone from an acute bed in return. Bearing in mind the reduction in the number of beds, that is not always possible.
Some months ago I visited a local authority home where an elderly lady who had been refused admission to Billinge hospital was being cared for by staff who were on their day off. Those staff members worked in shifts. They were the only people who were prepared to accept responsibility for that frail elderly lady. That is the position in which we find ourselves because of the unplanned explosion of market forces in health care.
As my hon. Friend the Member for Preston (Mrs. Wise) said, irrespective of political views, what we have heard from both sides of the House today drives us to ask what we can do to extricate ourselves from this morass. The Minister, whether he accepts or rejects the new clause, owes it to the House and to all those involved in community care to state precisely what his intentions are. I pressed the Minister for Social Security many times to advise us what the Department would do to protect residents from the problem of eviction. He ignored those opportunities to clarify the Government's position.
This matter has been treated with cynicism. We are talking about a finite group, many of whom are elderly and frail. Some people believe that, if we wait four, five or six years, most of those elderly people will die, and the problem will die with them. If that is the conclusion of advisers to the Department, it is totally unacceptable. For every elderly frail person in a private residential home, there is at least one elderly frail person at home trying to cope financially or socially.
Many of the people who see me about their parents are themselves either pensioners or are coming up to pensionable age. Many people have mentally or physically handicapped relatives at home and have seen their parents die. The brothers and sisters are left to cope with the handicapped person. The problem is passed on from generation to generation. If we do not accept the new clause, we shall pass on the problem of caring financially and socially not only to parents but to grandchildren. That is unacceptable in social and economic terms.
Like other hon. Members, I could tell horror stories about what happens to our constituents. Families find themselves in serious financial problems, some needing £10 or £15 a week and others needing £60 or £70 a week. Unbelievable sacrifices are made by people individually and collectively to maintain the family in the home, but they are driven to suffering illness and to seeking expensive respite care or other assistance from a local authority or the NHS.
The proposed system in the new clause is not only financially fair to those who will benefit from it but in the medium and longer term will be much more cost effective to the Government in terms of the votes of money to the local authority, the NHS or the Department of Social Security. Given the total votes to those three organisations involved in community care, it would seem far easier to provide, as the new clause does, a consistent means of maintaining financial assistance to those who will remain in residential or nursing home care. The new clause is a genuine attempt to find a way through a serious and increasing problem in the private sector.
I have been a Member for only a short time, but I know that hon. Members are usually in conflict and that some can take what I say or leave it. Whatever region we come from and whatever political party we represent, the same


problem arises. We are driven inexorably to the same possible solution. Even if the Government will not say that they are wrong, we hope that they will accept, just as they did in evidence to the Select Committee, that a serious problem exists. I hope that, because of practical debate on an all-party basis, for the first time since I became a Member we have come up with a solution that is acceptable to our constituents and in terms of the Government's financial targets.
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Many families look to this debate for not only a financial solution but a solution to the long-term care needs of those families. I should like the Minister to investigate one matter involving Springfield home in Wigan. It is a local authority home which, as a result of negotiation, last year moved into the voluntary sector because of an agreement between the local authority, the care organisation and residents. At the time of the transfer, there were negotiations as to which residents could apply for and receive attendance allowance at the higher or lower rates. In about September, agreements were reached on specific residents. I understand that, in the past few weeks, the Department decided that residents who came under the control of the local authority before last August were no longer eligible for the allowances, which have now been withdrawn. That is astonishing and unacceptable. I ask the Minister to investigate that as a matter of urgency.
Hon. Members have seen such transfers take place in their areas on the basis of additional allowances being made available to assist the people in those homes. If that is not to be Government policy, it will have serious effects in terms of the transfer arrangements and the financial requirements of the residents. For those reasons, I ask the Minister to accept the new clause.

Mr. Peter Griffiths: Some of my hon. Friends invited me to sign my name to the new clause. Although I said that I had considerable sympathy with it, I declined to append my name. I felt that it was desirable to have a debate on the subject and for my right hon. and learned Friend the Secretary of State to know that there were those who had not made up their mind about how to vote before hearing what was said.
The position that I should like to describe has been well rehearsed by hon. Members—including the hon. Member for Livingston (Mr. Cook) and my hon. Friend the Member for Maidstone (Miss Widdecombe)—Who have said that the problem will exist not just between now and April 1991 but will continue for those who are either already in residential homes or who will need to turn to income support to meet their costs.
A city such as Portsmouth, which I represent with my hon. Friend the Member for Portsmouth, South (Mr. Martin), has particular problems. Portsmouth is the second, or perhaps third, most densely populated area in this country. Land and property are extremely expensive. Until a few years ago, it was a low-wage area, dependent on the Navy, the dockyard and the women's clothing industry. Many of the elderly who live in residential homes did not enjoy the high wages and salaries that younger people in Portsmouth can enjoy because of the high-tech industries. If they made savings, as many did, they did so out of pitifully low wages. They assumed that they would be able to look after themselves in their old age as far as possible, but they believed that if their savings fell short of

the amount necessary to meet their needs—they would, of course, be sorry if that happened—they could carry on living reasonably comfortably and in reasonable dignity. They did not have especially high demands. They have moved into residential care, often initially at their expense, and paid the costs, only to find later that they have had to turn to income support to meet the costs of their continued residence.
The difficulty is that the costs are high in a city such as Portsmouth. As I have said, it is an extremely densely populated city and property is expensive. We now have the problem of high interest rates, which make it difficult for the owners of homes to expand and to carry out repairs. We also have higher wages than we had before, which means that to find the high quality of staff required is an expensive business. It is not the case that there is a one-off shortfall between the rates that are paid by income support and the charges in the residential homes, but that there is a growing shortfall. It has grown over recent years and shows no sign of ceasing. That problem must be addressed.
There are always hard cases, and the most extreme case may not be the most suitable to use in developing an argument. However, I want to mention briefly one case which, I should have thought, would commend itself to the Government. It is the case of a maiden lady who spent her lifetime caring for her parents and kept them out of care by looking after them. When she became too frail to look after herself living alone—she has no children, of course—she moved into residential care using her savings. She intended to look after herself and such self-reliance commends itself to the Government. I also find such self-reliance extremely commendable. That lady made proper provision. The trouble was that, as the years passed, her savings dwindled. In the end, her savings fell below the level at which she could turn to income support.
There is a gap between the income support payable and the fees. No one could say that the fees in that home are unreasonable. They are the fees that this lady chose and she was willing to spend her life savings on them. It is not likely that they are excessive or unreasonable. They are the fees necessary to maintain the service in that home. However, this lady can no longer pay. The owner of the home is allowing her to stay there. In fact, he is accepting that she pays less than others in the home, which means that his business is damaged. He could not do that for a steadily increasing number of people. The next stage is that those in the home who are paying their own way from their savings have to pay a little bit more to cover the costs of those who are drawing income support, which means that their savings are going down faster than they would have done otherwise. They are moving towards the same position that this lady is in at a rate that they did not anticipate.
That is a case in which there is need for a clear-cut approach to the problem. I asked the former Under-Secretary of State for Social Security, my hon. Friend the Member for Fareham (Mr. Lloyd), what was the position in this lady's case. He said that, unfortunately, income support did not meet the total cost of residential care. I wrote back and said, "I know that, but what is the old lady to do?" I am sorry to say that the answer was, "Are there no charities that could be found to help?" Was it suggested that the old lady should find a charity or that I should go round looking for charities to support my elderly constituent, who had made every effort after a lifetime of caring to look after herself? Such a solution will not do.
That old lady may stay in that home until she dies. If the numbers of such people increase, they will have to be moved from one residential home to another. I hope that my right hon. Friend the Secretary of State for Social Security will answer me later. Is it reasonable that if someone has expended all his savings at a particular home in which he was prepared to meet the costs, assuming that his savings would last his lifetime, and if he lives rather longer, he should, in the twilight of his life, be moved out into less suitable accommodation, which he would not have chosen for himself? Is that what my right hon. Friend is suggesting? If it is, it will not do any more than the suggestion that I should look for a charity. We need something better than that.
I do not suggest that the new clause is the only way to deal with the problem. There may be other and better solutions. I realise that there is a problem that if, in effect, we increased the resources available to the Department of Social Security clients in residential homes, charges might rise, which would place an unreasonable burden on those trying to pay for themselves. I can see that there is a difficulty, and I understand that it is not a simple matter, but a complex problem.
My right hon. Friend tonight does not have to accept the new clause, but he must accept the responsibility. I do not mind how he discharges that responsibility as long as he tells me tonight what I should say at the weekend to the proprietor of the residential home about the old lady. "You are to go on looking after her, come what may, out of your own pocket. You are to charge everyone else in the home a bit more. You are to put the old lady into cheaper and less satisfactory accommodation or go back to your Member of Parliament and tell him to look for anothercharity." Are those the solutions? If they are not, what is the Government's way of dealing with the problem? If it is convincing, I shall vote against the new clause tonight. However, unless there is an answer to those questions, I shall go into the Lobby in favour of the new clause, which will be the only thing that I can do in good conscience.

Mr. Kennedy: The speech of the hon. Member for Portsmouth, North (Mr. Griffiths) neatly, elegantly and beautifully encapsulated the practical and the moral dimensions of the problem. I hope that he will forgive me for not responding to his speech in particular. There have been three other contributions from Conservative Members that I found of particular interest.
Listening to the flow of this debate, only one or two rocks seem to have resisted the general current from hon. Members of all parties. I am reminded of a social security debate a few years ago. Some hon. Members will remember it and may have participated in it. The then Secretary of State was introducing a social security review. One controversial nugget was how child benefit would be dispensed—in the wage packet or directly to the mother.
There was an important debate that night in which every voice on the Government and Opposition Back Benches was of one view, and at the end of the debate the Secretary of State had to bow to pressure. He promised to re-examine the issue, and in due course, in another place, the proposals were amended. That was a sensible and welcome victory for Members in all parts of the House. I

hope that much the same will happen tonight because the measured, reasonable and constructuve tones of the majority of speeches demand that a change be made.
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The hon. Member for Cambridgeshire, South-West (Sir A. Grant) echoed my feelings when he fastened on to one of only three arguments that have been adduced against the new clause by Conservative Members. That argument is that we would be signing a blank cheque. Like the hon. Member for Cambridgeshire, South-West, I do not buy that idea—if one can buy a blank cheque—because, as the hon. Member for Maidstone (Miss Widdecombe) pointed out, if there can be a definition for one category of people, there is no reason why another category cannot be defined. The problem can be overcome.
The second argument was advanced by the hon. Member for Brigg and Cleethorpes (Mr. Brown), who thought that the clause would open the way for unscrupulous proprietors to ratchet up prices at the expense of the public purse. The few Conservative Members who support that argument are on thin ice because normally when we debate provision for the elderly there are exchanges between Labour Members, who are instinctively hostile to the private sector and would like to see social care provided in the public sector, and Conservative Members, who regard that as a pathological outlook and are critical of those on the Left who do not like private provision.
Perhaps I should make my position clear. I believe that it is inescapable, indeed essential, that we have a mixed economy in welfare, given the clear demographic trends in Britain. Conservative Members are on a hiding to nothing in saying that the new clause is defective because unscrupulous private profiteers would cause a strain on the public purse by trying to corrupt the system.
The same Conservative Members, when debating in other contexts, accuse Labour Members of being hysterical in complaining about private provision. They can argue one way or the other. They cannot invoke one side of the argument for one set of conditions and appeal to the other side of the argument for a different set of conditions. While I would not seek to defend the Socialist outlook, because I do not concur with it——

Mr. Campbell-Savours: The hon. Gentleman should join us.

Mr. Kennedy: The hon. Gentleman is older and greyer than I, but I suspect, from his choice of party, that he may not yet be wiser. We live in hope for him.
The third argument adduced by Conservative Members is always trotted out. It is that the drafting is indelicate and that technically the new clause would not meet the situation. I agree with the hon. Member for Cambridgeshire, South-West that where there is a will there is a way. We are not pushing the new clause in its present state. If the Minister accepts the spirit of it, and promises to introduce an amendment to achieve its purpose, we shall be satisfied. I hope that the Minister can pledge—even if he cannot accept the new clause as drafted—that the spirit behind it can be incorporated into the legislation at a later stage. I also hope—this refers to our initial discussions in Committee—that, when there is no legislation to be considered, a fresher, more detached, view


will be given to social policy in terms of the split between the Department of Social Security and the Department of Health.
There was much frustration in Committee because we felt that we were tilting at absent friends—the Ministers at the Department of Social Security. The Bill is being sponsored by the Department of Health. I am not sure that the split makes any sense any longer. I hope that, after the Bill is out of the way, fresh consideration will be given to which is the best all-encompassing sponsoring Department for a crucial and growing area of social provision and social policy.

Mr. Roger Sims: The arguments on this vexed matter have been compellingly presented by Members on both sides of the House with remarkable unanimity. Because of that, and because I spoke on the matter in Committee, I do not intend to detail them again. However, I must express my surprise and disappointment at the Government's failure to deal with the problem.
The Government have accepted that there is a problem and have built it into the White Paper and the Bill so that those who enter the system from April 1991 will not be affected. It is extraordinary that they apparently propose to do nothing about those already on income support. I say "apparently" because that appeared to be the evidence that Ministers from both Departments gave to the Select Committee, and it is also what emerged in Standing Committee. It is not as if that is a new problem that has suddenly arisen; it has existed for a year or more. I have corresponded with the Department about cases in my constituency for at least that long.
An important point was made by my hon. Friend the Member for Ealing, Acton (Sir G. Young). The money at present allocated to income support will—for new entrants after April—he allocated to local authorities to use as they think best. If that money is inadequate now, it will be inadequate then. Surely funding will be the basis of whether the proposals in the Bill succeed or fail.
The evidence is there in abundance. We all know the results of the research carried out by a variety of organisations, which have presented us with the facts and figures. It appears that the only place where research is thin on the ground is at the Department. It may have the material, but apparently it is reluctant to offer it to us. I invite Ministers to examine the Select Committee report, in which we have analysed the evidence and the inevitable conclusions.
To those figures, I will add two from my constituency, which is part of the suburbia to which the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) referred. The limit for income support there is £163. The charges for homes in my constituency vary from the lowest shared rooms at £185 to others at £280. I am referring not to luxurious places, but to houses that offer people a reasonable, fairly basic standard of accommodation.
The other case to which I wish to draw attention involves the Cheshire home in my constituency. Its administrator says:
we are…fortunate in that a few Local Authorities, in spite of the regulations, have…agreed to 'top-up'…This still leaves us with two residents for whom there is a shortfall of £84·86 per week (the difference between our current fee…and the DSS maximum of £258)".

That current fee is audited by the local authority. In any case, one would hardly expect a Cheshire home to overcharge. As a result, the home is losing nearly £9,000 a year in income, and that clearly cannot go on.
Not all people in residential homes are in difficulty. Some have their own capital from which they can pay fees. Some find themselves on income support but the family can bridge the gap, and that may not be unreasonable if they are a family of some means. But, alas, some families simply do not have such means. As we have heard, they have to scrape round charities finding £10 here and £10 there to fill the gap. Yet others simply have no family and no other source of income. Therefore, as in the case of the Cheshire home to which I have just referred, they have to be subsidised.
Surely those are the poeple whom we should be trying to help. If we do not do so now, after April 1991 there will be two classes of resident in residential homes—those who have recently entered whose costs will be fully met by the local authority, and those who entered before April 1991 who will be subject to the social security rate of benefit as it is now and presumably will be then. That problem must be addressed not in April 1991 but now. The problem exists now and will continue to do so.
It is the Government's policy not to dish out resources willy-nilly but to target help where it is most needed. If the debate has done nothing else, it has demonstrated that those are just the people to whom the help should be targeted. I cannot believe that it is beyond the wit of man or woman to devise a scheme to ensure that that is done.
I have no doubt that when my right hon. Friend the Minister replies he will say, as others have, that for all sorts of reasons the clause is defective. But if all that he can offer us is that he will bear in mind what has been said at the next uprating, that will not be good enough. The next uprating will not be announced until October to take effect the following April. In telling us that the new clause is unacceptable, I hope that he will be able to tell us what the Government intend to do about the matter. If he cannot do so, I shall have no alternative but to support the new clause.

Ms. Primarolo: The quickest and simplest solution to the problem that we are debating would be for the Government to stop the move towards private homes and to provide such services within the NHS and the social services. We would not then need to work out a formula for a top-up payment for someone receiving income support.
On a number of occasions, I have written to the Department of Social Security and the Department of Health about the problem that we are debating and their answers would be amusing if it were not for the tragedies behind them. The first time I wrote was November 1989 in response to a letter that I received from Bristol Old People's Welfare Incorporated on the upgrading that had been announced. They were complaining about the increase of £10. They pointed out that out of 175 residents they had 80 who relied on income support, and that in 1987 their loss was £35,000, in 1988 it was £83,000, and in 1989 they expected it to be £100,000; and that as a charity they could not afford to continue to draw on their resources and therefore would have to close some of their places.
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The Minister's reply was, first, that he was sorry to hear about the difficulties facing the charity. Secondly, he was sorry that it felt that the £10 was ungenerous. But then he went on to say of the £10:
This is an indication of our appreciation of the difficulties facing some people in homes and is a clear statement of our commitment towards helping those who need care and funding of community care.
He went on to say:
It is our policy to target the available resources to where the need is greatest and where such targeting would prove most effective.
It comes back to the point that my hon. Friend the Member for Livingston (Mr. Cook) made in opening the debate. If these people are on income support, they have no other money. Therefore, how could targeting be any more effective than by giving it to the very people who have nothing? The Minister said:
It was never the intention from the introduction of income support that it would meet the cost of all the fees".
He went on to say:
other methods of topping up"—by relatives, charities and other sources—"—[Official Report, 27 November 1989; Vol. 162, c. 422.]
are essential to this part of the system.
We have heard about relatives and about the difficulties with charities. Perhaps the Minister will tell us what the "other sources" are, because those people on income support do not have any other resources; that is why they are on income support.

Mrs. Mahon: I can assure my hon. Friend that when we had the first wave of elderly people being moved out of long-stay hospitals into the private sector there was no hint whatsoever that there would be any shortfall between the income of the elderly people and the cost of the home.

Ms. Primarolo: I agree with my hon. Friend. In fact, such a role for charities and relatives was never made explicit, either, at the beginning of the introduction of this policy.
I turn briefly to the case of the chronically sick, who also come within this clause. I shall use the example of a constituent because it demonstrates the utter disaster zone of the Bill. This woman—I will not name her, for personal reasons expressed by the family—is 48 years old and is suffering from Huntington's chorea, a tragic and unpleasant disease for anybody, let alone somebody so young. Her husband gave up work in 1986 in order to care for his wife and their 13-year-old daughter in the home rather than have his wife in hospital.
Unfortunately, the disease has progressed and even with respite care, which the family has had to use frequently, the husband is incapable of providing the intensive nursing care which his wife needs. Dearly as he loves her, there is no way he can afford to provide that care. His wife is currently in a hospital which is due for closure. She is in an acute bed which is not satisfactory for her treatment. In addition, the hospital is outside the district health authority region in which the woman resides. She is a resident of Bristol and Weston district health authority which is in the final stage of opting out as a district health authority.
The hospital's advice to the husband, who is unemployed, is to seek a suitable nursing home for his wife. There are no public sector nursing homes in Avon. She can go only to a private home. The husband has gone to 16 private nursing homes. Because of the intensity of the

nursing that she requires, only one will accept her. She has to get out of hospital but she cannot go home and the only private nursing home which will accept her wants her to pay £320 per week. Her total entitlement to benefit is £235 a week, which leaves a shortfall of £85. The husband has been round an untold number of charities and has finally been able to reduce the deficit to £45. The family cannot get the woman into a nursing home because it cannot find the £45. What are we doing to the so-called care of the vulnerable chronically sick through the Bill?
I wrote to the Department of Social Security and also to the Department of Health from who I got interesting replies. I was told again that the policy of the DSS was to direct available resources where they were most needed, that there was no provision in the National Health Service for providing nursing care and that it had never been the intention to fund all care from social security. The Department of Health told me that the National Health Service has a responsibility for providing continual nursing care and medical care for people in need of full-time care. However, it is for local health authorities to determine the level of care. Our district health authority is on its way out of the integrated NHS.
The Department of Health also told me that if the woman was in a private home she could not be moved, but she has not got into a home yet. The recommended course was to see the family general practitioner who is obliged to provide all the necessary medical evidence to patients, including referral to a hospital for care, if needed, and is medically responsible for that care. If necessary, the Department said that the woman should be admitted as an emergency case. That would mean that she would go straight back into an acute bed in the NHS simply because the Department will not make up the shortfall through income support. I cannot believe that the entire retinue of civil servants in the Department of Social Security and the Department of Health cannot work out a solution to this dreadful problem.
I have an offer to make to both the Secretary of State for Health and the Secretary of State for Social Security. If they feel unable to persuade their civil servants and to help them to reach a certain conclusion and so bridge the gap on income support, if my hon. Friend the Member for Livingston does not jump at the chance, I will help those civil servants to find a way of solving this disgusting and tragic problem. Anyone who claims that the problem cannot be solved is ignorant of people's ability to solve problems. Either Ministers have the political will to solve the problem or they have not. Voting in favour of the new clause is a solution to the problem.

Mr. Roger Gale: My right hon. Friend the Secretary of State for Social Security is aware that a need exists which must be met. The Government's provisions to meet the requirements of the Griffiths report and the Bill go a long way—and a brave way—towards meeting the needs for the future. I believe that the provisions will work. That leaves my right hon. Friend the Secretary of State to face the needs of today.
To some extent, I believe that we are the victims of our own success and that may be a happy circumstance. The residential care of the elderly has improved dramatically over the past 10 years. We inherited a shambles and a system in which the standard of care was bad in many cases. The facilities were poor and not infrequently the management of homes was greedy or corrupt.
The Registered Homes Act 1984 did much to improve the position and the financial provisions made by the Government have solved many of the problems and cured much of the greed that existed earlier. Although the present system is by no means perfect—I speak from experience in my constituency—we have many residential and nursing homes in which the facilities are excellent and the standard of care is very good. In those homes the standard of training is also good and school leavers are no longer thrown straight into the deep end without training. In my constituency the Thanet technical college provides excellent care training.
There have been many improvements, but they have all had to be paid for—and they have all been paid for—by the proprietors of homes. Inevitably, the fees in those homes now reflect necessity and not avarice. As my hon. Friends have heard tonight, many residents in those homes cannot now meet the legitimate financial needs of the proprietors.
My hon. Friend the Member for Maidstone (Miss Widdecombe) in her excellent speech referred to many of the problems and I do not propose to repeat them. Many of us believe that it is right that children should make some provision for their elderly parents. However, in many of the cases about which we are concerned, the children are not 30, 40 or 50-year-old working people, but 60 and 70-year-old children keeping 80 or 90-year-old parents—such is the level of care that is being provided. That is why in some respects we are victims of our own success. That gap must be met and my right hon. Friend the Secretary of State for Social Security must find a way of meeting it.
I listened with great care to my hon. Friend the Member for Mid-Kent (Mr. Rowe) and I agreed with a great deal of what he said. I believe that the new clause is flawed and I do not believe that it meets the needs that nearly every hon. Member who has spoken tonight agrees exists.
The awards should not be inconsistent with contracts awarded to new entrants under the new scheme. There are still homes that provide an inadequate standard of care and existing contracts may well he of a lower quality than that demanded for the award of new contracts. It would be bizarre if had homes were protected at the expense of good ones.
My hon. Friends the Members for Mid-Kent and for Chislehurst (Mr. Sims) referred to the priority of need. We have a tremendous priority of need in Kent for the care of the physically handicapped and the mentally handicapped young. My hon. Friend the Member for Chislehurst referred to the problems that are faced by the Cheshire homes and to their inadequate resources. Given that I am told that young people in need of considerable care represent a cost to those homes of between £350 and £400 per week, it is clear that the Cheshire homes are running at a considerable cost, as is borne out by the Strode Park Foundation for the Disabled, which has a youth unit in my constituency.
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The funding is inadequate and that gap must be made up. However, I would not wish that gap to be made up from the funding that will be made available to local authorities in the next few years because inevitably the resources that are needed for other areas of care will be depleted to meet the needs of the present.
I also listened with great care to the speech of my hon. Friend the Member for Ealing, Acton (Sir G. Young). Of

all the proposals that I have heard in three and a half hours in the Chamber, my hon. Friend's proposal struck me as the best. I repeat what I said at the beginning of my speech: the Secretary of State has taken on board and recognised the needs of the future. That is reflected in the Bill. It is essential that he now recognises the needs of the present. Therefore, I hope that he will pay particular attention to the suggestion of my hon. Friend the Member for Ealing, Acton.

Mr. Jim Cousins: In every sense of the term, it is far too late for us to be trying to interest the Government in a whole range of possible solutions. The opportunities for that lie further back down the track. We are now faced with the start of a new and complicated system of which the matter that we are discussing forms an important part.
I do not identify myself with those hon. Members of all parties who have tried to entertain the Government with a range of possible solutions to this difficulty. Although it is teasing, I do not find it tempting to see the hon. Member for Ealing, Acton (Sir G. Young) in action because he:is never a man to back up against a wall without first designing several different doorways. I identify myself much more strongly with the hon. Member for Chislehurst (Mr. Sims) who said clearly that now—tonight—when the Secretary of State replies to the debate is the time at which there can be an answer. We cannot go on debating a clear, obvious and substantial problem without having a definite answer on the table.
It is right and proper that the Government should find the answer themselves, because the problem with which we are wrestling is largely a creation of the Government's policies. The hon. Member for Thanet, North (Mr. Gale) referred to the position when the Government came into power, when there were 12,000 claimants on what was then supplementary benefit, but which is now residential care and nursing home support. In 1984, that figure had risen to only 40,000. However, the figure is now in excess of 180,000 and the number is rising rapidly. That has not happened by accident. It has happened as a result of a clear, conscious, definite and decided policy. In 1984 that policy substantially increased the levels of supplementary benefit—now income support—to encourage that trend and from then on rolled down the number of long-stay hospital provisions in which such people were then located.
The magical "perverse incentive" that has been mentioned as increasing those numbers does not exist. What has driven those numbers up is the Government's own policy of closing down long-stay hospitals and—more importantly—of preventing people from entering them because they were no longer there to be entered. That policy may well have had its good aspects, but tonight we are dealing with some of its unfortunate and bad consequences. What has happened has been as a result of the Government's clear policies and the Government must now find an answer to the difficulty that they have created.
We are talking not only about the 180,000 people who are dependent now on income support for residential care and nursing home provision but the several tens of thousands of people who, by April 1991, will be in that position. Conservative Members and several of my hon. Friends, including my hon. Friend the Member for Bristol,


South (Ms. Primarolo), spoke about the wave of transfers into dependency on income support as the shift out of the NHS sector gathers enormous speed.
In my city at least five different schemes will transfer many hundreds of people from NHS care into dependence on income support by April 1991. We are talking about not only the 200,000 who are dependent now but the extra tens of thousands who will have been put in that position by April 1991.
I agree with the hon. Member for Ealing, Acton on one point. Residential care rates under income support will be the basic building blocks of the funding of the system after April 1991. All the difficulties of the present system that we have debated tonight will be exported into the new system. That is why the matter is urgent and why it is proper for the Government to come up with some definite answers to a problem that is massively important in human, financial and institutional terms and that they have created.
An interesting factor lies behind the problem. We have seen the creation of a whole new industry of providing care to people who are dependent on income support. As little as five or six years ago it was a cottage industry but since then we have seen one of the most massive industrial rationalisation schemes that the Government have carried out. The voluntary sector mobilised itself to provide huge numbers of additional places to take advantage, as they thought, of residential care income support rates, only to be disappointed. We have heard tales of woe from Anchor Housing, Cheshire homes and other agencies. They are all true. Charities moved into the provision of such care thinking that the 1984 income support rates would be the basic building blocks of the new system only to find that in the years after 1984 the rates did not keep up with inflation.
We now find ourselves in grave difficulty. The Minister must find an answer to the problem. When he replies, he must say clearly how he intends to pitch the new scales that will come into force in April 1991 for people who are dependent on income support now. That flow of funds will be the stream that carries us on to the system of community care after April 1991.
The matter is important and urgent. We have seen an enormous industrial rationalisation in human care and the generation of a big business out of a cottage industry. I doubt whether the provision of care should be big or business, but that is what we have come to. Tonight, not to start a new debate that will rattle on for the foreseeable future, but to close the existing debate, the Minister must be definite and talk specifics about levels of funding, not only for the 200,000 people who now depend on income support but the whole rafts of other people whose futures will depend on it.
The wave of stress and anxiety about the figures is enormous. In 1989 the range of scales under income support went from £140 to £255. Payments were pitched to the individual average claimant at £120. In other words, average claimants do not depend entirely on income support. They have not reached the crisis point, but their savings are being bled through the means testing of the income support system. They demand answers and want rescue The ocean of anxiety that they represent must be drained and that cannot be postponed any longer.

Mr. Jack: I have been listening carefully to hours of this important debate. Nobody can ignore the issue which my right hon. Friend the Secretary of State needs to address in his remarks.
New clause 1 is not precisely the solution to the problem, nor is a return of the whole private care machinery to the public sector, as Labour Members have suggested. I am encouraged in that view by the statistics for Lancashire. In the county council budget debate on the community charge, it was made clear that if the council's part III accommodation were offered to the private sector, 38 per cent. of it would not pass the county council's own care standards of inspection.
I reject new clause 1 because of a case in my constituency. A rest home was upgraded to nursing home status and went from an income support level base of fees to one geared to income support, because it knew that the people in the rest home could afford to pay those fees and no more. Down the road somebody thought that he could do better, so he upgraded an old rest and nursing home to a high quality one and put it on the market at £330 a week. It will not surprise hon. Members to hear that the market, if one can call it that, quickly made it clear that it would attract too few residents, so the price came down to £300 a week in an attempt to attract more people.
We have heard about differentials. That is one of £60. I have visited both establishments and I am still left wondering which one—the former rest home providing an excellent standard of individual care for £240 a week or the new luxurious nursing home which charges £300 a week—is better and should be supported.

Miss Widdecombe: rose——

Mr. Jack: I reluctantly decline to give way because I want to finish in a few moments.
The matter is a deal more complex than simply needing additional money for the existing system of income support. In all sincerity I would not for a moment dispute that we need to consider the adequacy of some of those rates because costs vary. It is not just a case of tightening the system.
Labour Members who understand the income support system will realise that if elderly people adjust their financial circumstances in advance of going to a rest home, their family may be the beneficiary of a large sum and they may end up being able to claim income support. If we are to make the best use of the large sums rightly invested in income support, my right hon. Friend in reaching a conclusion must look further than simply the straightforward rate for the job. Income support anomalies create difficulties. If one of two elderly friends who bought a house together goes into a nursing home and seeks income support because as part-owner of the house his capital is tied up, he cannot get that much-needed benefit. I urge my right hon. Friend to encompass such cases when he comes to a conclusion.
Nobody would for a moment dispute the excellent job done by private rest and nursing homes, but already there is a big difference in the price charged. For example, one person in my constituency who runs a rest home has been innovative in order to improve business potential and has developed a domiciliary care service. That adds greatly to services and to his cash flow and it improves the work that he does. It means that he can maintain care for people in his rest home at a rate equal to what they can get on


income support. I ask my right hon. Friend to reconsider the rate. To those hon. Members who are seduced by the simplicity of new clause 1, I say that the issue is not as straightforward as they imagine.

Mr. Ieuan Wyn Jones (Ynys Môn): I have sat throughout most of the debate and have heard the almost unanimous view of hon. Members on both sides of the House that something must be done about a group of people who find themselves in great difficulty. Many hon. Members have said that they are a particularly vulnerable group of elderly people.
What has been remarkable about the debate is that there is no political divide in the House, as both sides agree that this is a major problem which the Government must resolve. The old adversarial system of politics in the Chamber has been put to one side in a remarkable way. We have been able to set aside that style of politics because we have an unanswerable case for the Government and they must come up with a solution. The case is unanswerable because no hon. Member from either side of the House has resorted to the safe haven of trading statistics. Whenever we have an empty case which we cannot support we seek refuge in statistics, but no hon. Member has done that tonight.
We have all had personal experience of constituents coming to us with problems, and we know that the Government must find a solution. Some Conservative Members have agreed with the principle behind new clause 1, but they are not happy about the wording, as it could lead to what some hon. Members have described as a blank cheque. Those Conservative Members have offered their own solution to the problem, and have suggested an answer different from that contained in new clause 1, but that clause has not been drafted to be perfect in every dot and comma. I accept that the clause could be amended. However, the House needs to give the Government a clear message tonight that something must be done. Unless the Government accept that, a group of elderly and vulnerable people will be devoid of assistance.
The will of the House is clear. Conservative Members who agree about this issue, but do not agree with every dot and comma in new clause 1, should realise that the only way to keep pressure on the Government is to vote for new clause 1. I am convinced that the Government will have to bow to that pressure.

The Secretary of State for Social Security (Mr. Tony Newton): Until recently, I had not expected to find myself once again confronting the hon. Member for Livingston (Mr. Cook). He was kind enough to say that it was a pleasure for him but, in the circumstances of the debate, I am not so sure that it is a pleasure for me.
We have certainly had an important and worthwhile debate, and I shall seek to respond in like fashion. I always look for common ground in an issue of this nature, and today the common ground is that the present system of income support limits is less than perfect, to put it mildly, for supporting the provision of residential and nursing care.
Since 1985, the system has sought to reflect variations in the needs of defined categories of people, but it has no mechanism or capacity to assess—in a medical or social work sense, as is often required—the needs and circumstances of an individual. As a consequence of that,

and of the high level of such payments by comparison with what is often available in terms of other forms of support, for example, in the home, it is widely held to have been inconsistent with the drive towards care in the community to have created some scope—some people would say more than some scope—for exploitation and to have left very considerable room for doubt whether the resources involved were being used to best effect.
The Government's clear acknowledgement of the unsatisfactory nature of the system—which in my case goes back many years to my earlier experience as a Social Security Minister—led to the proposal contained in the community care part of the Bill: that from April 1991, for new cases, the social security entitlement should be confined to the usual income support and housing benefit entitlement and that beyond that it should be the task of local authorities' social services departments or social work departments to assess an individual's care needs and to provide support for those needs in what is judged to be the most appropriate way, whether by paying for care in a residential care or nursing home or by paying for care in the person's own home. That approach is also, I believe, common ground.
The difficulty that we all face—sparticularly by me in the context of this debate—is the classic one for politicians on many political issues of getting from where we are to where we should like to be. The Government's judgment, which again is widely shared, is that it is not practicable to undertake a complete switch from one system to another at one particular point in time and that the change must be carried through in a phased and manageable way.
There are two main reasons for that judgment. The first is the one on which most stress has been placed: the huge burden that would be imposed on local authorities if the assessment process had to be undertaken not only for new cases but for nearly 200,000 existing cases, which could well make the whole thing unworkable. The second reason, which is certainly not to be dismissed or minimised, is that it was not thought right to withdraw existing entitlements to income support from those who are already in residential homes, with all the uncertainty that that could involve, especially in circumstances where it would be possible for local authorities to assess such people as not needing to be in a home at all. There is broad agreement that for those two reasons it was right not to attempt a wholesale switch at once.
Unless that basic judgment is challenged—which it has not been throughout the debate—there is an inescapable need to run the two systems side by side, despite the fact that that must entail some problems. What I and my right hon. and learned Friend the Secretary of State for Health intend to do is to ensure that, to the best of my ability, both systems operate effectively.
The new clause is directed towards one aspect of those problems—the future basis of income support payments under the existing system to those who will have preserved entitlements. I say at once, fairly and squarely to the House, that I cannot advise it to accept the new clause. It contains two main elements: first, that any gap between the income support limit and the actual charge should be measured and then met. I shall turn in a moment to the apparent safeguard. The second element is that the amount then defined should be increased according to an index of the average by which those charges are subsequently increased.
There is an attempted safeguard. I acknowledge that my hon. Friend the Member for Maidstone (Miss Widdecombe) and other hon. Members have attached some weight to it: that payment could be withheld in respect of some part of the charge that is held by a social security adjudication officer to be "unreasonable", having regard to the nature of the premises and the services provided. That is a judgment which social security adjudication officers do not have, and could not sensibly acquire, the training or the knowledge to make. It involves social work skills and assessment skills of a kind that are outwith the ordinary operation of the social security system. Even attempting to make it work would entail imposing a burden on local authority social services departments. It would be essential to use their advice on a large scale, and that would multiply their problems in implementing the new system.

Mr. Frank Field: Has not the hon. Member for Ealing, Acton (Sir G. Young) given the answer? Adjudication officers will not act in a vacuum. Running parallel to their decisions will be local authority market decisions about private homes. In deciding whether a rate is reasonable, it will be possible to look at all those decisions. The hon. Member for Maidstone (Miss Widdecombe) has provided a formula which, with that back-up, would work.

Mr. Newton: That is a helpful and entirely reasonable comment, as I should expect from the hon. Gentleman. Indeed, later in my remarks I shall come to the very constructive contribution of my hon. Friend the Member for Ealing, Acton (Sir G. Young). The very way in which the hon. Member for Birkenhead (Mr. Field) framed his remarks implies acceptance that, certainly as things stand, social security adjudication officers do not have the capacity to make judgments——

Mr. Field: But not in a vacuum.

Mr. Newton: I have told the hon. Gentleman that I will come to that point. He knows a great deal about how the social security system works and about the training and skills of adjudication officers. I do no more than make the point that, as things stand, they do not have the capacity to make the judgments that that apparent safeguard would entail.
Anybody who doubts that might look back at what happened when we had a system rather similar to that proposed in the new clause. I refer to the period before 1981 and running up to 1985, when adjudication officers were responsible for establishing what was a reasonable charge in each local office area. Let me take from the list two examples that are particularly striking. In the case of charges thought to be reasonable for nursing homes, there was a variation from £296 in Leytonstone to £140—less than half—in Romford, which is just down the road.
In the case of residential care homes in East Anglia, there was a variation from £90 in Bury St. Edmunds to £177 in Colchester. Manifestly, that reflects the extent to which adjudication officers found it impossible to make judgments of the sort envisaged in this new clause.

Mr. Field: The figures that the Minister has just quoted are impressive, but they are irrelevant to this argument. We are not moving back to the system that pertained in the period up to 1985; we are moving to a system under which

local authorities will have to negotiate care packages from the private sector. Adjudication officers, in deciding whether a rate is reasonable, will be able to consider what the market will bear.

Mr. Newton: I should be grateful if the hon. Gentleman would let me do what I have already undertaken to do. I have said that I will come to that point later. In the context of the debate and of my response to it, it is sensible for me to comment on the new clause as it stands and to convey my clear sense—this view has been reflected in the speeches of at least five of my hon. Friends—of the substantial degree of open-ended commitment which would raise costs all round.
Perhaps it is simply an oversight on the part of the authors of the new clause—I have no wish to rest my case on technical drafting—but no provision is proposed to take account of whether it is reasonable for the accommodation, however elaborate and expensive, to be provided at public expense.
In my judgment, there would be three principal effects were the proposal, in the form that it takes in this new clause, to be carried into law. First, and most obviously, there would be an immediate transfer to the taxpayer of a large amount of expenditure that is currently undertaken privately. That would by no means be only the private expenditure undertaken in the circumstances that concern my hon. Friend the Member for Maidstone. The system that we operated until 1985 has been criticised by hon. Members and the Social Services Select Committee in earlier reports. At the time of the change to national limits specified by categories of home, it was specifically made clear that the Government did not think it right to set the limits at a level that would cover all charges in all homes. The package introduced unique provisions in relation to what was formerly supplementary benefit——

It being Ten o'clock, the debate stood adjourned.

Ordered,
That, at this day's sitting, the National Health Service and Community Care Bill may be proceeded with, though opposed, until any hour.—[Mr. Greg Knight.]

Question again proposed, That the clause be read a Second time.

Mr. Newton: Those provisions which are unique to what was supplementary benefit and is now income support allow relatives to make payments in support of residents in such homes without the amounts being immediately knocked off their income support. In any other circumstances, a payment of, say, £50 a week would immediately reduce income support by £50 a week.
I do not want to place too much weight on this point, because I am conscious of the sort of cases that concern hon. Members. Those provisions were introduced specifically in recognition of the fact that there would be cases where either relatives or, perhaps even more often, charitable bodies would wish to make payments to support someone in care beyond what the state could be expected to provide. In recent weeks, that has been acknowledged by some people from charitable bodies in conversations with me. As I said, I do not want to place too much weight on it, but I need to make it clear to the House that part of the topping up does not have the character attributed to it by some hon. Members, although of course part does.
I suspect that there would be almost universal agreement on my next point. Throughout the past 10 years, what the Department of Social Security pays has


been a powerful influence on the prices charged. The immediate effect of the new clause would be to drive up prices all round, to the disadvantage not least of local authorities seeking to negotiate care packages under the new system. That risk cannot be dismissed, given the Laing and Buisson survey—to which little reference has been made, somewhat to my surprise—which shows a bunching of minimum charges in homes at, or just above, the level set by the DSS. That has been the tendency throughout the lifetime of these arrangements. The new clause would aggravate that position and would bid up prices, to the disadvantage of those paying privately in such homes—of whom there are more than 100,000—and of local authorities in bargaining under the new system.

Dame Jill Knight: Does not the new clause put the power to judge in the hands of the Secretary of State?

Mr. Newton: No, it does not. It puts the power to judge in the hands of adjudication officers—

Mr. Frank Field: The power is in the hands of the Secretary of State.

Mr. Newton: The hon. Member for Birkenhead (Mr. Field) knows that the entire social security system has been set up to protect adjudication officers from being told what to do by the Secretary of State, and the hon. Member for Oldham, West (Mr. Meacher) knows that, too. That is the essential safeguard of the independence—if one likes, the judicial role-—of those making decisions in the social security system.
Thirdly, I have little doubt that the new clause, as it stands, would greatly reinforce, especially in the latter part of this year, all the so-called "perverse incentive" effects of income support arrangements, notably attracting into homes people who might be better cared for in the community. I also suspect-—I direct this point to Opposition Members, including the hon. Member for Wakefield (Mr. Hinchliffe)—that the new clause would tend to aggravate still further the extent to which some local authorities seek to shed some of their existing responsibilities on to the social security system. I suspect that such an outcome would not be welcomed universally by the Opposition, although there might be two views about it in some other quarters.
As I said earlier, anyone who doubts such risks need only look at the experience in the early 1980s, when we had a system of local office limits set by adjudication officers, varying as I have described. Between 1979 and 1984—the hon. Member for Newcastle upon Tyne, Central used the figures to make a slightly different point—expenditure on supplementary benefit in this respect rose 20 times, from £10 million to £200 million, while the number of people being helped rose little more than three times, from 12,000 to 40,000. There has been widespread criticism of exploitation of the system by home owners, which was echoed by the Select Committee on Social Services in the 1986 report. I do not believe that any hon. Member wants to go back down that path, which is the risk with the new clause as it stands.

Mr. Field: rose——

Mr. Newton: I shall come to the hon. Gentleman's point.
Although I cannot recommend the new clause to the House, that is not the same as declining to recognise the concern expressed by hon. Members of all parties or as being unwilling to seek to offer some clear assurance of our determination to fulfil our responsibilities to those with preserved income support entitlements.
Before I comment on my approach to the future increases of income support limits, I want to make two important points about two aspects of the Bill which were discussed extensively in Committee, and about the powers that my right hon. and learned Friend the Secretary of State proposes to take under clause 40. They are important in judging the balance of policy in this area.
First, as the House knows, my right hon. and learned Friend's intention under clause 40 is to bring forward regulations that will enable local authorities to top up preserved entitlements—as they may now, and in some cases do—for people under pensionable age. Their ability in that respect will be extended to people in nursing homes. That power will, as now, extend to people over pensionable age if the authority concerned had been topping up for two years or more before they reached that age.
Secondly, my right hon. and learned Friend also intends to ensure, through an amendment to this Bill—I know that this subject was the topic of considerable discussion in Committee—that local authorities will continue to have the role that they have always had, and which applies in the present system, to act as providers of last resort for those over pensionable age by making places available in their own residential accommodation to those whom they judge would otherwise be made homeless. I stress that not because I suggest that it answers the concerns tonight, but because it is relevant and answers the concern expressed elsewhere—which I share—that, as a result of inadvertence in drafting, an important part of the rights of those already in homes was being altered in an unintended way by the Bill: that is, the withdrawal of the right to be accommodated in part III accommodation should the need arise. It is important to ensure that that right is preserved.

Mrs. Elizabeth Peacock: Will my right hon. Friend tell the House what the many of us whose constituents are at the stage where they could be turned out, and whose relatives have no more money arid whose local authority has no accommodation, are to tell them?

Mr. Newton: I hope I made it clear that I was raising the point because it has been important in the context of the discussions on this matter as a whole, but that I was not presenting it as an answer to the concerns that have been expressed, and I was about to touch on the social security points that have been made in the debate.
Before departing from my comments on the Bill, I should say—this has been the subject of considerable discussion here and in Committee—that my right hon. and learned Friend has asked me to underline his flan commitment to monitoring carefully future developments on the use of the power under clause 40. The House will know that that is a wide power and that it was inserted in the Bill in consultation with me. It gives a great deal of flexibility to respond, should experience show that further steps are needed in respect of action by local authorities.
I have deliberately put those points first because I recognise that the focus of the debate has been about, and the request to me by Members in all parts of the House has been for me to recognise, the importance of the social security dimension of the problem.
I assure the House—I do so with more than conventional strength—that I have listened carefully to what has been said in almost all of the debate and that I can give a number of undertakings which, I must point out, do not constitute specific commitments about what financial limits will be in place, for example in April 1991, and about the spirit in which I shall approach that difficult task in the light of the important points that have been made in the debate.
As hon. Members—certainly the Chairman of the Select Committee, my hon. Friend the Member for Eastleigh (Sir D. Price), and others who play an important role in that Committee—will be aware, the Social Services Select Committee has recently produced an important report containing a number of points, not least on the need to improve the quality and quantity of information on which decisions about social security entitlement in this area can be based.
The hon. Member for Livingston (Mr. Cook) will acknowledge, in the way in which he normally approaches these issues, that that difficulty has faced successive Ministers and Social Services Select Committees for some time, and not only in respect of the information that we gather through the social security system, which is dependent on the accuracy—not always to be guaranteed—of the information from private and voluntary homes, especially perhaps the former.
In some ways, the Laing and Buisson report, to which I and others have referred, revealed the difficulty. The response rate was only 28 per cent., and it left a number of question marks over the validity of the information as a whole. There is also the problem, in assessing precisely what information one requires and how best to get it, that many homes do not cater for residents or potential residents who are likely to be dependent on Department of Social Security payments. So there are difficult issues as to precisely about which homes one needs the information on which to base realistic judgments concerning social security entitlement.
Having said all that to demonstrate the difficulties that have faced us, I should say clearly that I accept that we need more and better information, and when I respond to the Select Committee, as I hope to do before long, I shall make specific proposals to meet the suggestion in one of its recommendations on that front.

Mr. Frank Field: I am sure that not only the Select Committee but the whole House is grateful for the right hon. Gentleman's assurances about his desire to collect better statistics. Taking collectively our elderly constituents who are not having their fees paid in full—this was stated earlier in the debate—each hon. Member has the equivalent of two whole streets of people facing eviction. These are frail, elderly, often confused old people. Although we are grateful that in future we shall have better statistics, we want answers from the Minister about what we should do with those 160 on average elderly people whom each of us has in our constituencies facing possible eviction.

Mr. Newton: I understand the hon. Gentleman's point; he made it in his speech. The new clause, however, relates to the position after April 1991. For the hon. Gentleman to suggest that I can respond now to a suggestion about a regime to be set up in 12 or 13 months' time lacks the reasonableness that I expect from him. I am seeking to show, as clearly and as forthcomingly as I can, how I propose to respond to the concern that is reflected in the new clause—to which I am properly directing my attention—about the position after April 1991.

Mr. Michael Colvin: In bracketing nursing care homes and residential care homes together, my right hon. Friend has not addressed the special needs of nursing homes. In the past four years there has been a welcome increase of about 50 per cent. in nurses' pay, which constitutes about 60 per cent. of the direct operating costs of nursing homes. In that period Government support has increased by 17 per cent., while the direct operating costs of nursing homes have increased by 39 per cent. There is a 20 per cent. shortfall. Does not my right hon. Friend think that he should make special provision for nursing homes, although he may not fully meet what we want for residential care homes?

Mr. Newton: I acknowledge the need to examine the particular circumstances of certain types of home. If my hon. Friend's memory is long enough—we go back to a period when I was the Minister for Social Security—he will remember that that problem was clearly acknowledged in 1985 and 1986 by substantial increases in the limits for nursing homes. That means that in the past five or six years—since the present arrangements started—there has been a significant real increase in help for nursing homes. That is not to say that I will not examine the special case of nursing homes. I give my hon. Friend that clear undertaking.

Mr. Patrick Cormack: To use my right hon. Friend's words, there is a significant and real problem that is widely recognised. Can he hang the phraseology and accept the principle?

Mr. Newton: I am not absolutely clear what the principle is. Is my hon. Friend asking me to accept the principle of the new clause—that we should measure the gap between what a home is charging and what income support is available without regard to the factors that I have mentioned, including whether it is reasonable to expect accommodation to be provided at public expense, regardless of how elaborate it may be? That is what the new clause says, and for that reason I cannot give my hon. Friend the simple answer that he obviously wants.

Mr. Cormack: I am not seeking to trip up my right hon. Friend; I am merely trying to help him. There is a problem that is widely recognised and broadly identified in the new clause. There is a principle there that can be accepted. Can my right hon. Friend say unequivocally that he accepts it, and that in another place a Government-devised clause will be introduced to meet the essential points that have been made repeatedly during this debate?

Mr. Newton: Several of my hon. Friends have made suggestions relating to the possibility of greater geographical variation of limits. More particularly, there has been the suggestion referred to several times by the


hon. Member for Birkenhead, adverting to an important speech made by my hon. Friend the Member for Ealing, Acton, that it may be possible, using the information that will become available as a result of practical decisions and negotiations by local authorities after 1991, to reflect what I think my hon. Friend wants, which is income support limits that he would regard as more realistic than those which he is looking at today.

Sir David Price: Does my right hon. Friend accept the conclusion in the Select Committee's report that
the problem is basically an expression of present
inadequacies in the level of social security benefits. It is not caused by the plans in the White Paper, but it will be exacerbated by them
so it is open to an immediate solution?

Mr. Newton: As I said, the new clause is directed at the position after April 1991. Therefore, my comments are properly directed principally to that end. In the course of considering the uprating of the income support rates following the £10 increase that is about to come into effect, which I announced in the uprating statement last October, and in looking ahead at future upratings which have been the focus of concerns expressed in the debate, I shall look at—again I use the phrase with more than conventional force-—the points that have been made about geographical variation and, in particular, at the comments of my hon. Friend the Member for Ealing, Acton.
Geographical variation already applies to London.I looked at the matter carefully in the course of making the decision last October about the uprating that is about to come into effect, and I was predisposed in its favour. However, I came to the conclusion that there was no sufficiently safe basis for drawing geographical distinctions in the way that some people have urged, not least for the reason that has been echoed in the debate—that the apparently common sense presumption that costs are likely to be higher in the south-east than in the north-west did not appear to be borne out entirely by the information that we had at our disposal. Without a secure basis for drawing up such distinctions, I thought it best to put the £100 million of additional resources into the rates generally.
My reservations at that time about geographical limits have been reflected in some of the comments in the debate. I shall look seriously at the scope for greater geographical variations, which might be particularly important to some of my hon. Friends from Kent and Hampshire, for example, but I am much more attracted to the suggestion of my hon. Friend the Member for Ealing, Acton that we should make greater use of something that could be dealt with on a rather more localised basis—I doubt whether it could be used in each local DSS office area—which is what local authorities will negotiate on individual cases rather than with actual homes.

Mr. Beaumont-Dark: We understand that my right hon. Friend is a compassionate man, but does he accept that this is not just a matter of regional variation? We are not talking about statistics; we are talking about people. Does my right hon. Friend understand the point that was made at the beginning of the debate about whether, if people are not being exploited—I hope that there is a way of checking that—the Government are willing to protect them, or do people have to go into old-fashioned geriatric wards? If my right hon. Friend can answer that, we shall know which way to vote.

Mr. Newton: My hon. Friend has asked me a question that I can answer in reasonably straightforward terms. It is certainly our wish to protect the kind of people who have been the focus of so much concern in this debate. The cause of my unwillingness to accept the new clause as it stands is that it would not enable me to fulfil the other half of what my hon. Friend has pressed upon me, which is to prevent exploitation in some circumstances, including exploitation of the very people whom we are seeking to help.
I said that I wished to say a word or two more about the suggestion of my hon. Friend the Member for Ealing, Acton, endorsed by the hon. Member for Birkenhead, about using the additional information that will become available from 1991 onwards. It must be acknowledged that there will not be much information around in advance of 1991. There are, of course, a number of uncertainties about precisely how the new system will operate in this respect with local authorities. From my conversations with, for example, leaders of the Association of Directors of Social Services, and with some of the charitable arid voluntary bodies, it is clear that thought is being given to and discussions are taking place on negotiating in certain circumstances on a national or regional basis rather than leaving the negotiation to individual local authorities. So we would have to take account of that. It might be helpful in some ways, but it does not lend itself straightforwardly and simply to the sort of proposition that the hon. Gentleman was urging on me.
Equally, there may well be people in homes in which local authorities would not choose to place people, in which case that would not give us the sort of information that is required. Again, it is a complicating factor in the point that has been pressed on me. There is the possibility that some local authorities will negotiate packages of care and contracts that are not directly comparable with the arrangements under income support.
I mention those points only to show that it is not possible for me simply to say snap to the proposition urged on me at this moment, but that does not detract in any way from my undertaking to seek, in considering how we are to carry out uprating and respond to the concerns that have been expressed from all parts of the House, to use the better practical information that will arise, as the hon. Member for Birkenhead has stressed, from the workings of the new system.

Mr. Rowe: Will my right hon. Friend also undertake that in that important survey of the information as it becomes available he will include a regular survey of the number of places in residential homes that remain available? At present there is serious danger that the introduction of the new system and the shortfall that we have been discussing will lead to an incomparably rapid closure of very large numbers of homes.

Mr. Newton: I am not sure that I accept the latter part of my hon. Friend's suggestion, but I can certainly respond with a clear-cut yes to the first part of what he said.

Sir George Young: My right hon. Friend has been most helpful in outlining a possible solution. Does he have the powers to pay income support to residents on the basis that he has just outlined? If he does not, is he prepared to amend the Social Security Bill to give himself those powers?

Mr. Newton: My hon. Friend refers to the basis that I have just outlined. I have indicated some convincing reasons, I think and certainly hope, why the simple proposition that income support limits shall be based on what local authorities pay in particular homes is not one to which I can readily assent in quite that form, for the reasons that I have given. We have extensive powers to set limits. My intention would be to use those powers in a way which made use of the sort of information to which my hon. Friend has referred. If on further reflection in the aftermath of the debate—I shall certainly do some further reflection—I come to the conclusion that there is an additional power that I could sensibly take to assist us in dealing with these problems in the future, I would be prepared to seek the appropriate amendment to the Social Security Bill.
It is in the nature of the changes on which we are embarked, with widespread agreement on the objectives, that no one can be certain a year ahead of all the circumstances at the time, but I hope that what I have been able to say in explaining to the House why I cannot accept the new clause has shown our readiness not only to acknowledge legitimate concerns but to do everything to meet them, consistent with the aim we all share, which is the best interests of people in these homes.

Mr. Robin Cook: I am conscious that the House wishes to come to a decision and I shall make my response to the debate brief. We have had a full debate since I initiated it some five hours ago. Many hon. Members have addressed the House. I think that those who have been present throughout would agree that the debate was without party spirit. In my concluding remarks I shall try to address the matter again without party spirit, as I sought to do in my opening remarks.
Before turning to the Secretary of State's speech, may I say that I was impressed time and again by the way in which so many hon. Members who addressed the question with the open mind came back to the same two difficult questions posed early in the debate by the hon. Member for Maidstone (Miss Widdecombe).
The first question is, if we say that it is right and proper that there should be a gap between income support payments and the charges levied by residential care homes, who do we say should meet the gap and pay the extra? It cannot be the residents, because they are on income support. By definition they have no means themselves to meet the gap. I noticed that the Secretary of State did not reply to that question which has lingered throughout the debate. I pose it to him again. Who does he imagine will fill the gap if he does not? Is it assumed that it will be the relatives? If so, what is assumed to be a reasonable contribution from relatives, who are themselves frequently pensioners? It is a question to which local authorities would like to know the answer, because from April of next year they will accept the responsibility for new residents. Are they expected to look for a contribution from relatives in the way that we seem to be implying in the Bill?
The second question that ran through the debate is very simple. Those same local authorities are expected from April of next year to negotiate payments to private residential care homes for the residents who will enter the homes from that date. It is assumed that they will be capable of negotiating presumably reasonable charges

which will not result in exploitation of the public purse or unreasonable profits for those running the homes. Although it is assumed that local authorities will be capable of doing that from April of next year, we are told there is no way in which the Department of Social Security can achieve the same in relation to those who are already in private residential care homes. If the Department of Social Security cannot do it, what is to stop the Department using as its local benchmark the figure that local authorities can negotiate, using block contracts? Or are we seriously being asked to accept a position which may exist from April of next year in which the local authority payments may be higher than the income support levels being paid to private residents living in the same residential care homes, and unable to meet a payment which the local authority accepts as reasonable?
I want to respond to some of the Secretary of State's replies. It would be unreasonable not to begin by saying that he addressed the House with his characteristic urbanity and frankness which I remember. I remind him that a telling speech was made by the hon. Member for Chislehurst (Mr. Sims). He said that it would not be enough to ask us to wait for an uprating in April 1991, which is more than a full year away.
I have read the submissions from the many voluntary organisations that have written to hon. Members on both sides of the House, and it is clear that by April 1991 thousands of elderly people will have faced' eviction from residential care homes because they cannot afford the fees. The Secretary of State referred to safeguards. What safeguards can he offer to the House? What comfort can he offer to people who face the prospect of eviction within the next 12 months? [HON. MEMBERS: "What would you do?"] I have moved a new clause that is drafted to address the matter. If hon. Members want to do something about it, they should support the new clause.

Mr. Newton: The hon. Gentleman would not want to mislead the House. The new clause is directed towards producing something that will happen in April 1991.

Mr. Cook: I was going to address the points about my new clause later, but I will deal with them now.
I am aware that the new clause is not a thing of beauty or great perfection. In my many years in this House moving from the Back Benches behind the Government to the Opposition Front Bench, I have never produced an amendment or new clause that did not turn out to be technically deficient in 15 different ways. [Interruption.] The Secretary of State for Health has been uncharacteristically silent throughout the debate. It would assist our proceedings if he remained silent until it ends. I aspire to exchange places with the Secretary of State for Social Security because, if that were to happen, some day I might be able to move an amendment that was not technically defective.
I am prepared to consider the issue of the commencement date. If safeguards are lacking and my safeguards are not sufficiently tightly worded, I am perfectly content to amend them; all those details can be addressed in another place. We are not concerned now with a Committee stage, line-by-line examination of the new clause. We are concerned now with whether the clause should be added to the Bill. That brings us to the issue of principle.
The Secretary of State did not simply ask the hon. Member for Chislehurst to wait until April 1991. I noted carefully the two points on which he was specific about what he might do in April 1991. To be fair to the Secretary of State, he is always candid, although his candour may not always help him. He was frank and there were only two specific points on uprating next year which he is willing to look again.
The right hon. Gentleman's first assurance was that there would be more information. I would be the last person to resist more information. However, we know enough to reach a judgment on the issue. Over the next three days hon. Members will hear me say that on many occasions. I have received more material and briefings from so many organisations about new clause 1 than about any other. We do not require more information; we need action to resolve the problems.
The second point that the Secretary of State offered to consider was geographical variation. With his characteristic candour the Secretary of State was frank and admitted that we are not dealing with a problem that is confined to any one region. It is found in virtually every region. My hon. Friends the Members for Halifax (Mrs. Mahon), for Newcastle upon Tyne, Central (Mr. Cousins) and for Makerfield (Mr. McCartney) all addressed the House passionately about cases in their constituencies. I fear that those problems would not be addressed by a new regional variation. If we are to resolve this problem, we must look not only at Kent and Hampshire, but across Britain. 
That brings me to the remarks that passed between the Secretary of State and his hon. Friend the Member for Staffordshire, South (Mr. Cormack). When the hon. Gentleman intervened, the Secretary of State said to him, "What is the issue of principle?" The issue of principle on which the new clause stands is the principle as it affects those many elderly people, now numbering 100,000 or so, who entered residential care on the clear understanding that the state had undertaken to provide them with the income support to meet the charges of those homes and to meet their subsistence while resident in such a home. The issue of principle is whether the House is willing to renege on that commitment and on its contract with those people on the basis that we never said—although we never denied—that it was intended to meet the full charges of those homes. To me that is an important issue of principle because it touches on the integrity and the probity of our standing as a House, willing to respond to the needs of our constituents.
It was said by the Minister—and spectacularly by the hon. Member for Brigg and Cleethorpes (Mr. Brown)—that if my new clause was passed it could result in some exploitive landlords, providers of luxurious accommodation, ripping off the public purse. The hon. Member for Brigg and Cleethorpes held up the spectacle of us, through the new clause, subsidising owners of private care homes who wake up their residents with a glass of sherry every morning. I could accept the argument that there is a danger of our subsidising exploitive and luxuriant accommodation if only a minority of homes were unable to get within the income support limits. However, the truth is that the great majority of homes cannot live within the income support limits. Never mind the profit-making sector, some homes run by voluntary organisations, which are not making a profit, exploitive or otherwise, cannot get within them.
In my opening speech, I drew the attention of the House to the case of a home that is run by nuns, with a vow of poverty, who cannot get within the income support limits. No morning sherry in that case, I suspect. If one looks across the broad swathe of provision, it is patent that the present income support levels are wholly unrealistic.
The Secretary of State warns us against making an open-ended commitment, but I warn him of the open-ended commitment that will result if we do not pass the new clause or something like it. I advise the Secretary of State for Health that I am referring to the open-ended commitment of the NHS to take back the people who might be put on the streets from the private residential care homes. I cannot imagine a more expensive or a more open-ended commitment than that.

Mr. Barry Porter: I have followed the arguments of the last half or three quarters of an hour with care and understood every question that has been asked, but I have not understood one answer. Am I to understand—perhaps either the hon. Gentleman or someone else could tell me—that there is a danger, a probability or a certainty that some old people will be removed from their present accommodation? [HON. MEMBERS:"Yes."] If that be the case, how can anybody support it? [Interruption.]

Mr. Cook: If my hon. Friends will permit me to continue, it has been in my mind to mention to the hon. Member for Wirral, South (Mr. Porter) that under the rules of procedure only I could respond to his question, but I am beaten to the punch. Hon. Members of all parties know that many people, including their own constituents, face precisely that risk.
May I conclude with this point, which I address to Conservative Members as they make up their minds about how to vote? I am confident that, if we carry the new clause, Ministers will move rapidly to correct in the other place any imperfections of drafting. I am not equally confident that if Conservative Members support the Government in the vote on the principle of the new clause, they will move equally rapidly to solve the problem. This is the chance that the House has to tackle the problem. This is the chance that we have to do justice to those constituents who, through no fault of their own, find themselves in a distressing, desperate financial crisis to which there is no end in sight. I urge the House not to lose that chance.

Question put, That the clause be read a Second time:—

The House divided: Ayes 256, Noes 253.

Division No. 114]
[11.01 pm


AYES


Abbott, Ms Diane
Fearn, Ronald


Adams, Allen (Paisley N)
Field, Frank (Birkenhead)


Allason, Rupert
Fields, Terry (L'pool B G'n)


Alton, David
Fisher, Mark


Armstrong, Hilary
Flannery, Martin


Ashdown, Rt Hon Paddy
Flynn, Paul


Banks, Tony (Newham NW)
Forsythe, Clifford (Antrim S)


Barnes, Harry (Derbyshire NE)
Foster, Derek


Barnes, Mrs Rosie (Greenwich)
Foulkes, George


Barron, Kevin
Fraser, John


Battle, John
Fyfe, Maria


Beckett, Margaret
Gardiner, George


Beith, A. J.
Garrett, John (Norwich South)


Bell, Stuart
George, Bruce


Bendall, Vivian
Gilbert, Rt Hon Dr John


Benn, Rt Hon Tony
Godman, Dr Norman A.


Bennett, A. F. (D'nt'n &amp; R'dish)
Golding, Mrs Llin


Bermingham, Gerald
Gordon, Mildred


Blunkett, David
Gould, Bryan


Boateng, Paul
Graham, Thomas


Boyes, Roland
Greenway, John (Ryedale)


Bradley, Keith
Griffiths, Nigel (Edinburgh S)


Brown, Gordon (D'mline E)
Griffiths, Win (Bridgend)


Brown, Nicholas (Newcastle E)
Hardy, Peter


Brown, Ron (Edinburgh Leith)
Harman, Ms Harriet


Bruce, Malcolm (Gordon)
Hattersley, Rt Hon Roy


Buchan, Norman
Hayes, Jerry


Buckley, George J.
Hayhoe, Rt Hon Sir Barney


Caborn, Richard
Henderson, Doug


Campbell, Menzies (Fife NE)
Hicks, Robert (Cornwall SE)


Campbell, Ron (Blyth Valley)
Hinchliffe, David


Campbell-Savours, D. N.
Hoey, Ms Kate (Vauxhall)


Cartwright, John
Home Robertson, John


Clarke, Tom (Monklands W)
Hood, Jimmy


Clay, Bob
Howarth, George (Knowsley N)


Clelland, David
Howells, Dr. Kim (Pontypridd)


Clwyd, Mrs Ann
Hoyle, Doug


Cohen, Harry
Hughes, John (Coventry NE)


Coleman, Donald
Hughes, Robert (Aberdeen N)


Colvin, Michael
Hughes, Simon (Southwark)


Cook, Frank (Stockton N)
Ingram, Adam


Cook, Robin (Livingston)
Irving, Sir Charles


Cormack, Patrick
Janner, Greville


Cousins, Jim
Jones, Barry (Alyn &amp; Deeside)


Crowther, Stan
Jones, leuan (Ynys Môn)


Cryer, Bob
Jones, Martyn (Clwyd S W)


Cummings, John
Kennedy, Charles


Dalyell, Tarn
Kiifedder, James


Darling, Alistair
Kirkwood, Archy


Davies, Rt Hon Denzil (Llanelli)
Knight, Dame Jill (Edgbaston)


Davies, Ron (Caerphilly)
Lamond, James


Davis, Terry (B'ham Hodge H'l)
Leadbitter, Ted


Day, Stephen
Lestor, Joan (Eccles)


Dewar, Donald
Lewis, Terry


Dixon, Don
Livsey, Richard


Dobson, Frank
Lloyd, Tony (Stretford)


Doran, Frank
McAvoy, Thomas


Douglas, Dick
McCartney, Ian


Duffy, A. E. P.
Macdonald, Calum A.


Dunnachie, Jimmy
McFall, John


Eadie, Alexander
McKelvey, William


Eastham, Ken
McLeish, Henry


Evans, John (St Helens N)
Maclennan, Robert


Ewing, Harry (Falkirk E)
McNamara, Kevin


Ewing, Mrs Margaret (Moray)
Madden, Max


Fatchett, Derek
Mahon, Mrs Alice


Faulds, Andrew
Marek, Dr John






Marshall, Jim (Leicester S)
Sheerman, Barry


Martin, Michael J. (Springburn)
Sheldon, Rt Hon Robert


Martlew, Eric
Shore, Rt Hon Peter


Maxton, John
Short, Clare


Meacher, Michael
Sillars, Jim


Meale, Alan
Skinner, Dennis


Meyer, Sir Anthony
Smith, Andrew (Oxford E)


Michael, Alun
Smith, C. (Isl'ton &amp; F'bury)


Michie, Bill (Sheffield Heeley)
Smith, J. P. (Vale of Glam)


Michie, Mrs Ray (Arg'l &amp; Bute)
Smyth, Rev Martin (Belfast S)


Mitchell, Austin (G't Grimsby)
Spearing, Nigel


Molyneaux, Rt Hon James
Steel, Rt Hon Sir David


Morgan, Rhodri
Steinberg, Gerry


Morley, Elliot
Stott, Roger


Morris, Rt Hon A. (W'shawe)
Straw, Jack


Mowlam, Marjorie
Taylor, Mrs Ann (Dewsbury)


Mullin, Chris
Taylor, Matthew (Truro)


Murphy, Paul
Taylor, Teddy (S'end E)


Oakes, Rt Hon Gordon
Temple-Morris, Peter


O'Brien, William
Thompson, Jack (Wansbeck)


O'Neill, Martin
Turner, Dennis


Orme, Rt Hon Stanley
Wallace, James


Patchett, Terry
Walley, Joan


Peacock, Mrs Elizabeth
Wardell, Gareth (Gower)


Pendry, Tom
Wareing, Robert N.


Pike, Peter L.
Welsh, Andrew (Angus E)


Powell, Ray (Ogmore)
Welsh, Michael (Doncaster N)


Prescott, John
Widdecombe, Ann


Primarolo, Dawn
Wigley, Dafydd


Quin, Ms Joyce
Williams, Rt Hon Alan


Rathbone, Tim
Williams, Alan W. (Carm'then)


Redmond, Martin
Wilson, Brian


Rees, Rt Hon Merlyn
Winnick, David


Reid, Dr John
Winterton, Mrs Ann


Richardson, Jo
Winterton, Nicholas


Robertson, George
Wise, Mrs Audrey


Robinson, Geoffrey
Wolfson, Mark


Rogers, Allan
Woodcock, Dr. Mike


Rooker, Jeff
Young, David (Bolton SE)


Ross, Ernie (Dundee W)
Young, Sir George (Acton)


Ross, William (Londonderry E)



Rowlands, Ted
Tellers for the Ayes:


Ruddock, Joan
Mr. Allen McKay and Mr. Frank Haynes.


Salmond, Alex



Sedgemore, Brian





NOES


Alexander, Richard
Bruce, Ian (Dorset South)


Alison, Rt Hon Michael
Buck, Sir Antony


Amery, Rt Hon Julian
Budgen, Nicholas


Amess, David
Burns, Simon


Amos, Alan
Butcher, John


Arbuthnot, James
Butler, Chris


Arnold, Jacques (Gravesham)
Butterfill, John


Arnold, Tom (Hazel Grove)
Carlisle, John, (Luton N)


Atkins, Robert
Carlisle, Kenneth (Lincoln)


Baker, Rt Hon K. (Mole Valley)
Carrington, Matthew


Baker, Nicholas (Dorset N)
Carttiss, Michael


Baldry, Tony
Cash, William


Banks, Robert (Harrogate)
Chalker, Rt Hon Mrs Lynda


Batiste, Spencer
Channon, Rt Hon Paul


Bellingham, Henry
Chapman, Sydney


Bennett, Nicholas (Pembroke)
Clark, Sir W. (Croydon S)


Benyon, W.
Clarke, Rt Hon K. (Rushcliffe)


Biffen, Rt Hon John
Conway, Derek


Blaker, Rt Hon Sir Peter
Coombs, Anthony (Wyre F'rest)


Body, Sir Richard
Coombs, Simon (Swindon)


Bonsor, Sir Nicholas
Cope, Rt Hon John


Boscawen, Hon Robert
Couchman, James


Boswell, Tim
Cran, James


Bottomley, Peter
Currie, Mrs Edwina


Bottomley, Mrs Virginia
Curry, David


Bowden, Gerald (Dulwich)
Davies, Q. (Stamf'd &amp; Spald'g)


Bowis, John
Davis, David (Boothferry)


Boyson, Rt Hon Dr Sir Rhodes
Dorrell, Stephen


Braine, Rt Hon Sir Bernard
Douglas-Hamilton, Lord James


Brazier, Julian
Dover, Den


Bright, Graham
Dunn, Bob


Brooke, Rt Hon Peter
Eggar, Tim


Brown, Michael (Brigg &amp; Cl't's)
Emery, Sir Peter





Evans, David (Welwyn Hatf'd)
McLoughlin, Patrick


Evennett, David
McNair-Wilson, Sir Michael


Fallon, Michael
Madel, David


Favell, Tony
Major, Rt Hon John


Fenner, Dame Peggy
Malins, Humfrey


Field, Barry (Isle of Wight)
Mans, Keith


Finsberg, Sir Geoffrey
Maples, John


Fishburn, John Dudley
Marland, Paul


Forman, Nigel
Marshall, John (Hendon S)


Forsyth, Michael (Stirling)
Marshall, Michael (Arundel)


Forth, Eric
Martin, David (Portsmouth S)


Fowler, Rt Hon Sir Norman
Mayhew, Rt Hon Sir Patrick


Fox, Sir Marcus
Mills, Iain


Franks, Cecil
Miscampbell, Norman


Freeman, Roger
Mitchell, Andrew (Gedling)


French, Douglas
Mitchell, Sir David


Garel-Jones, Tristan
Moate, Roger


Gill, Christopher
Monro, Sir Hector


Glyn, Dr Sir Alan
Montgomery, Sir Fergus


Goodson-Wickes, Dr Charles
Moss, Malcolm


Gorman, Mrs Teresa
Neale, Gerrard


Gorst, John
Nelson, Anthony


Gow, Ian
Neubert, Michael


Grant, Sir Anthony (CambsSW)
Newton, Rt Hon Tony


Greenway, Harry (Ealing N)
Nicholls, Patrick


Gregory, Conal
Nicholson, David (Taunton)


Grist, Ian
Nicholson, Emma (Devon West)


Ground, Patrick
Onslow, Rt Hon Cranley


Grylls, Michael
Oppenheim, Phillip


Hague, William
Paice, James


Hamilton, Hon Archie (Epsom)
Patnick, Irvine


Hamilton, Neil (Tatton)
Patten, Rt Hon Chris (Bath)


Hampson, Dr Keith
Patten, Rt Hon John


Hanley, Jeremy
Pawsey, James


Hannam, John
Porter, Barry (Wirral S)


Hargreaves, A. (B'ham H'll Gr')
Porter, David (Waveney)


Harris, David
Raffan, Keith


Hawkins, Christopher
Raison, Rt Hon Timothy


Hayward, Robert
Redwood, John


Heathcoat-Amory, David
Renton, Rt Hon Tim


Hicks, Mrs Maureen (Wolv' NE)
Rhodes James, Robert


Higgins, Rt Hon Terence L.
Ridsdale, Sir Julian


Hind, Kenneth
Rifkind, Rt Hon Malcolm


Holt, Richard
Roe, Mrs Marion


Hordern, Sir Peter
Rossi, Sir Hugh


Howarth, Alan (Strat'd-on-A)
Rowe, Andrew


Howell, Ralph (North Norfolk)
Rumbold, Mrs Angela


Hughes, Robert G. (Harrow W)
Ryder, Richard


Hunt, David (Wirral W)
Sackville, Hon Tom


Hurd, Rt Hon Douglas
Sayeed, Jonathan


Irvine, Michael
Scott, Rt Hon Nicholas


Jack, Michael
Shaw, Sir Giles (Pudsey)


Jackson, Robert
Shaw, Sir Michael (Scarb')


Janman, Tim
Shephard, Mrs G. (Norfolk SW)


Jessel, Toby
Shepherd, Colin (Hereford)


Jones, Gwilym (Cardiff N)
Shersby, Michael


Jones, Robert B (Herts W)
Skeet, Sir Trevor


Kellett-Bowman, Dame Elaine
Smith, Tim (Beaconsfield)


Key, Robert
Spicer, Sir Jim (Dorset W)


King, Roger (B'ham N'thfield)
Spicer, Michael (S Worcs)


Kirkhope, Timothy
Stanbrook, Ivor


Knapman, Roger
Stanley, Rt Hon Sir John


Knight, Greg (Derby North)
Stevens, Lewis


Knox, David
Stewart, Andy (Sherwood)


Lamont, Rt Hon Norman
Stewart, Rt Hon Ian (Herts N)


Lang, Ian
Stokes, Sir John


Latham, Michael
Stradling Thomas, Sir John


Lawrence, Ivan
Sumberg, David


Lee, John (Pendle)
Summerson, Hugo


Leigh, Edward (Gainsbor'gh)
Tapsell, Sir Peter


Lennox-Boyd, Hon Mark
Taylor, Ian (Esher)


Lightbown, David
Taylor, John M (Solihull)


Lilley, Peter
Tebbit, Rt Hon Norman


Lloyd, Sir Ian (Havant)
Thatcher, Rt Hon Margaret


Lloyd, Peter (Fareham)
Thompson, D. (Calder Valley)


Lord, Michael
Thompson, Patrick (Norwich N)


Luce, Rt Hon Richard
Thorne, Neil


Lyell, Rt Hon Sir Nicholas
Thurnham, Peter


MacGregor, Rt Hon John
Townsend, Cyril D. (B'heath)


Maclean, David
Tracey, Richard






Tredinnick, David
Wardle, Charles (Bexhill)


Trippier, David
Watts, John


Trotter, Neville
Wheeler, Sir John


Twinn, Dr Ian
Wiggin, Jerry


Vaughan, Sir Gerard
Wilshire, David


Waddington, Rt Hon David
Wood, Timothy


Wakeham, Rt Hon John
Yeo, Tim


Waldegrave, Rt Hon William
Younger, Rt Hon George


Walker, Bill (T'side North)



Walker, Rt Hon P. (W'cester)
Tellers for the Noes:


Waller, Gary
Mr. Alastair Goodlad and Mr. Tony Durant.


Ward, John

Question accordingly agreed to

Motion made, and Question put, That the clause be added to the Bill:—

The House divided: Ayes 219,Noes246

Question accordingly negatived

Mr. Robin Cook: On a point of order, Mr. Speaker. The House has found a characteristic parliamentary device to express its view on the principle at stake while rejecting the flawed new clause. I invite the Secretary of State for Social Security to respond by agreeing that the Government will take on board the decision of the House on the matter of principle.

Hon. Members: Answer.

Mr. Newton: As the hon. Gentleman will realise, given that the Bill is the responsibility of my right hon. and learned Friend the Secretary of State for Health, I thought

it sensible to have a word with him before responding. The House declined to add new clause 1 to the Bill. The new clause concerns social security, which explains my response to the debate. I repeat what I said in my remarks at the end of the debate. I sought to acknowledge the concern expressed by hon. Members of all parties, which was manifestly reflected in the vote. It will be reflected in our consideration of what we shall do in the light of what I said at the end of the debate. I sought to suggest the ways in which we should move forward. I think that the hon. Gentleman will recognise that I cannot go beyond my undertakings given during the debate. They will be reflected faithfully in the light of the outcome of the debate.

Mr. Cook: Further to that point of order, Mr. Speaker. It is only fair to concentrate the mind of the Secretary of State for Social Security at this stage with the warning that the House will want to return to the matter at the Report stage of the Social Security Bill. I assure the right hon. Gentleman that we shall be considering the new clause again to ensure that on that occasion it will be a less flawed new clause which the House may be inclined not merely to give a Second Reading to, but to add to that Bill if there is no further Government action in the meantime.

New Clause 2

NATIONAL HEALTH SERVICE (SCOTLAND) ACT 1978: QUALITY CONTROL COMMISSION

'After section 7 of the National Health Service (Scotland) Act 1978 there shall be inserted—

(7A) Quality Control Commission

There shall be established a Quality Control Commission for the Health Service in Scotland. Its members including the chairman shall be appointed by the Secretary of State following consultation with Health Boards, local authorities, the CBI in Scotland, the Scottish Trade Union Congress and such other bodies as he considers appropriate. Its responsibilities will include:—
(a) establishing the standards that shall be met by Health Boards in carrying out its functions.
(b) carrying out investigations from time to time to ensure that such standards are being met.
(c) where any services have been put out to competitive tendering,ensuring that the standards of that service are maintained.
(d) where such services are not maintained, to instruct the Health Board to take such action as they consider necessary.
(e) to investigate complaints from patients in regard to the Health Service, and take such action as seems appropriate.".'—[Mr. Maxton.]

Brought up, and read the First time.

Mr. Maxton: I beg to move, That the clause be read a Second time.

Mr. Deputy Speaker (Sir Paul Dean): With this it will be convenient to take amendment (a), in line 11, leave out from 'time to time' and insert 'annually.'.

Mr. Maxton: It may be convenient for the House if I tell the hon. Member for Moray (Mrs. Ewing) that I am happy to accept amendment (a).
Following the controversy over new clause 1, and knowing the generosity of the Under-Secretary of State for Scotland, the hon. Member for Stirling (Mr. Forsyth), and the uncontroversial nature of new clause 2, I am certain that we shall not have such a vote again and that the Minister will be happy to accept the new clause. That will save the House and the Government considerable inconvenience.
The Minister has shown in the past 10 days that he is happy to establish new quangos in Scotland. He set up the new National Health Service management executive under Mr. Cruickshank last week, and earlier today he established new special health boards in Scotland. As he is merrily setting up quangos all over the place in Scotland, I feel certain that he will set up one more, as proposed in the new clause.

Mr. Michael Forsyth: The hon. Gentleman is wrong to describe the NHS management executive as a quango. It is a management executive within the Scottish Home and Health Department, being part of that Department. It is not a quango. The previous new clause did not set up a body, as the hon. Gentleman suggests; it gave the Secretary of State power to set up such bodies.

Mr. Maxton: As usual, the Minister is splitting hairs. I accept that the earlier new clause gave the Secretary of State power to establish special health boards, but I understand that in a written answer this afternoon he made it clear that he intends to use that power to establish a special health board in Scotland for the purpose of carrying out health education. Whatever one may call it, it

will be a quango. It may require the laying of an order under the negative procedure to bring it into being, but he intends to do that.
If the new management executive is to be appointed by the Scottish Home and Health Department from its employees, it will be a Civil Service body and not a quango. But he does not propose that course. He intends to bring in people from outside to be on it. In other words, the Minister is splitting hairs by contradicting me. In any event, I am sorry that he took so seriously what was intended to be a mild joke. Perhaps at this hour he has lost what little sense of humour he has.
The new clause is important, although perhaps not in its detail and technicality, because in the past 10 years we have experienced dramatic changes in the NHS in Scotland and in the demands made on it. Some of those demands have been outwith the control of the Government, such as the demographic changes throughout the nation which have resulted in fewer births at one end of the scale and many more elderly people at the other. Those changes have put strains on the NHS.
The dreadful new disease of AIDS is already causing problems in the Lothian health board area and will undoubtedly cause increasing problems to all the health boards in Scotland. Dramatic technological breakthroughs have given hope to many, but they are expensive both in terms of the operations involved, such as transplants, and the long-term costs in caring for the individuals who undergo such treatment.
In addition, there are the changes over which the Government have control. Particularly worrying to us are the changes that the Government have already initiated and those that will occur as a result of the Bill. We have had ever-increasing rises in prescription, dental and optical charges, with charges now for the testing of eyes and for limited dental treatment. In addition to changes affecting drugs on prescription lists, we have suffered the harsh and hasty imposition of the share formula in Scotland, with cuts in spending in the two largest health board areas, Glasgow and Lothian.
We have had the introduction of general managers and the privatisation of many NHS services, all of which have


caused patients and health boards great problems. Now we face the opting out of hospitals, fund-holding general practices, the internal market, indicative budgets and the need to ensure that the community care provisions in the Bill are properly implemented. At the same time, the Government are actively encouraging private medicine in Scotland, a concept that is foreign to the Scottish medical scene and is blurring the line between the public and private sectors.
Health boards, emboldened by the Minister's support, are seeking to extend privatisation well beyond the ancillary services: into radiography, laboratories, pharmacies, medical records and even kidney dialysis—and, of course, care for the elderly. Given such enormous developments and changes, it is essential that the quality of services should be monitored, and that quick and effective action should be taken to deal with any problems.
The Government constantly claim that all the changes in the Bill are designed to give patients a better and more responsive service. As a Glasgow Member, I find it hard to see how cutting funds for the Greater Glasgow health board year in, year out can improve services in a city with the unenviable reputation of having the worst urban health record in western Europe.
It is for the Government to prove their claims to the Scottish public. They are always giving statistics to show that they are spending more on the Health Service, that Glasgow and Lothian are the best-funded health authorities in Britain, and that more is spent per head on health in Scotland than anywhere else in Britain. I am sure that the Minister will give us the same statistics tonight that he has given us throughout his career as Health Minister. The problem is that no one in Scotland believes him: patients, doctors, nurses and other Health Service workers all think that the service has worsened since the Government came to power, and that the changes in the Bill—and the privatisation of services—will only make matters worse.
The new clause would establish a quality control commission for the Health Service in Scotland. I have given way to the popular Government norm of Government appointment, although I believe that it should be a matter for consultation with certain bodies. The commission will be empowered to establish certain defined qualities for each service, and to ensure that they are observed. Above all, if a service is privatised or put out to competitive tender, the commission will be able to monitor quality and ensure that it is improved if necessary. If the service fails to meet the previous standards—or the standards laid down by the commission—the commission will have the power to instruct the health board to end the contract and introduce in-house staff.
The Health Service in Scotland is no longer an integrated whole, and once the Bill goes through it will be even less so. It will not be possible to plan for the different components to work together informally to ensure that help is provided in the areas that they cover. Hospital cleaners and caterers—and, perhaps, radiographers, laboratory assistants, technicians and even those who work the dialysis machines—will no longer be responsible to, and the responsibility of, the management of their hospitals. Instead, they will be responsible to, and the responsibility of, other managers who may not even reside in the United Kingdom, let alone Scotland. International companies will be running many of the privatised

concerns. Such people cannot be seen as part and parcel of a Health Service team that is running a hospital in the way that they have been in the past.
If the Bill is enacted, we shall have opt-out hospitals and fund-holding practices. The Health Service will work on a contract basis. The opt-out hospitals will still be funded by the NHS and related to it by commercial contracts, but they will not be part and parcel of an integrated Health Service. Their facilities will be available to the Health Service but they will be separate from it and will operate quite differently from the rest of the Health Service.
11.30 pm
Even within the Health Service there will be the constant aim to seek contracts between different parts of the Health Service. The relationships will all exist on a separate commercial basis, not integrated and planned in the way that they have been in the past. Therefore, there must be some organisation such as that suggested in the new clause to ensure that the quality of the Health Service is maintained.
We oppose most of the Government's changes to the Health Service and we would like to reverse them. But while those changes are being made, it is essential that we try to maintain quality.

Mr. Kirkwood: I am following the hon. Gentleman"s argument closely, and I support the general thrust of Ins case, but why does he include the CBI in Scotland and the Scottish Trades Union Congress, neither of which organisation I object to, but no health care professionals on the quality control commission? Is that deliberate, and, if so, why?

Mr. Maxton: There are Health Service unions with the necessary expertise within the STUC. The new clause refers to other bodies that the Secretary of State considers appropriate, and that would include the health professionals about whom the hon. Gentleman is talking. I am sure that he has read the new clause sufficiently carefully to see that even though it may not be spelled out.
If the Government genuinely believe in their past reforms and those that they now seek to establish, and if they genuinely believe that those are in the interests of patients in Scotland, they will happily concede at least the principle of the new clause, even if they find fault with its wording. If they do not, the people of Scotland will rightly say that the purpose of the privatisation that has taken place and the other reforms in the Bill is not for the good of the patient or to improve the quality of service but, first, to give profits to large numbers of the Minister's friends and, secondly, to shift the Health Service in Scotland, as in the rest of the United Kingdom, towards a commercial Health Service which will eventually lead to the privatisation of the NHS and to a much greater use of private medicine by most of the population.
If we consider the privatisation of services in Scotland, we are entitled to be sceptical about its so-called advantages. Unlike England, the Scottish health boards were reluctant to go down the road of competitive tendering. In 1983, the then Minister for Health put out a circular asking health boards
to test the cost-effectiveness of their domestic, catering and laundry services by seeking tenders for these services from outside contractors and comparing them with the cost of in-house services.


It also asks boards in appropriate cases to let contracts to private firms.
Because the circular asked the health boards to do that, most—nearly all—simply said no. They did not want to have anything to do with privatisation. Even the Greater Glasgow health board unanimously voted against putting any of its services out to contract at that time. I have never managed to find out how she voted, but one of the then board members was Lady Goold, the wife of the then chairman of the Conservative party in Scotland. Apparently she was opposed to privatisation.
The boards conducted a series of negotiations with trade unions and came to agreements about improving—in inverted commas—the services that were being provided and seeking greater efficiency within the Health Service. However, along came the general election of 1987, the Minister with responsibility for health, John MacKay, lost his seat, and the Prime Minister and the Secretary of State had the difficult job of choosing a Minister of Health from the hon. Member for Tayside, North (Mr. Walker) and the hon. Member for Stirling (Mr. Forsyth). They decided that the hon. Member for Stirling, with all his ideological faults, would be a better Minister than the hon. Member for Tayside, North.

Mr. Bill Walker: I should like to put it on record that the Prime Minister made the right choice.

Mr. Maxton: Just for once I can say with an absolutely clear conscience that I agree with both the Prime Minister and the hon. Gentleman. Whatever the faults of the hon. Member for Stirling, and however difficult the choice might have been, I think that the Prime Minister made the right choice.
I do not intend to raise the matters raised by my hon. Friend the Member for Workington (Mr. Campbell-Savours), but not only is the hon. Member for Stirling an ideologue but he makes no bones about the fact that, prior to becoming a Minister, he had commercial interests in this issue. He has given them up, and I accept that absolutely, but the fact is that his previous business experience and his ideology lead him to believe in the privatisation of the Health Service, particularly of those services that can be put out to contract. As soon as he came to office, there was a drive towards the privatisation of the Health Service in Scotland.
The Minister organised a seminar on 2 October 1987 which was attended by health board general managers and chairmen, representatives of contractors and Scottish Home and Health Department officials. There the two parties were brought together and told, "Come on, we want to see privatisation." The boards' membership had changes, general managers, such as Laurence Peterken in Glasgow, had been appointed who were almost as comitted to privatisation as the hon. Member for Stirling, and the drive was on.
In December 1987, the Minister sent out a letter to general managers stating:
As you know, the Minister is very concerned that so little competitive tendering for support services has been undertaken in Scotland,
and wants things to move faster. It continued:
Competitive tendering for support services must be pursued with greater vigour.

The hon. Gentleman always says that it is a matter of competitive tendering, and that includes in-house tendering. That is right, but in the letter he did not say that that was where the health boards had to look first and that they should take greater account of the in-service tenders—far from it.
The letter stated that boards were directed to seek to co-operate with private contractors and specifically asked to explore options informally before tenders were invited, show a willingness to consider more flexible forms of contract, avoid over-complex tender documentation, provide adequate time for contractors to prepare bids and produce monitoring arrangements without being excessively burdensome to the contractor. The Government wanted to find the easy way of doing the job and ensure that it was made as easy as possible for those outside contractors. That is how we went down the road towards the privatisation of services in Scotland.
Since then there has been the contracting out of a fair number of services, but it is still early days to judge all of them. I accept that a few have been awarded to in-house tenders. However, even then it means a reduction in the service provided. To obtain that in-house contract often means cutting the number of people employed and a reduction in wages and overtime. Those employees often have to work shorter hours with considerably less pay. Although the work is better done by in-house teams than outside contractors, because fewer people are doing the work for less money it is less well done than in the past.
It is not simply a matter of whether a floor is cleaned properly or whether the auxiliary services that provide the tea do the job adequately; it is a question whether they are still part of the team. Once services have been contracted out, even to an in-house team, the bond between the workers in the hospital is broken, and that causes problems.

Mr. Michael Forsyth: I am listening carefully to the hon. Gentleman's fascinating remarks about competitive tendering. He does less than justice to the in-house work forces in the Health Service in Scotland, which have won three quarters of the contracts. Is he saying that standards are falling? Is he criticising the standards that were set out in the contract—which do not show a diminution of standards? Is he criticising the in-house teams for a failure to perform to the standards to which they committed themselves when they won the contract?

Mr. Maxton: That is the divide between us—the Minister believes that nothing can be done other than on a commercial contract. He cannot understand that people co-operate and work together as part of a team in the Health Service. He believes that everything is about cash and contracts.

Mr. Bill Walker: The hon. Gentleman is most courteous to give way, unlike some of his colleagues—[Interruption.] The hon. Gentleman is always courteous. I have listened carefully, but I find great difficulty in relating his remarks to occurrences during the winter of discontent, when all those people with their team spirit did everything that they could to destroy the working of our hospitals. They set out to destroy the Labour Government.

Mr. Maxton: I shall be rude, not courteous. The only mental quality that I have ever found in the hon. Gentleman is that he is much like an elephant—he has an


extremely long memory. All professionals in hospitals, from the doctors downwards, believe that they should operate as a team. Contracting out, whether or not in-house, breaks that bond. If people work for lower wages and with poorer conditions of service, their loyalty to the hospital and to the team is considerably less. They are bound to deliver a service at a certain price. They cannot exceed it.
I know that the hon. Gentleman has spent some time in hospital following an accident. He must agree about the psychological impact of a friendly ward orderly. He is an untrained worker whose job is to sweep up or to pour cups of tea for patients and nurses. He feels that he is part of a team. Because of his loyalty, his impact on the psychology of patients is enormous. I have seen it in operation. When we privatise and bring in the commercial element, we break the loyalty, and the position gets worse.
11.45 pm
The Minister is right; three quarters of the contracts have been won by in-house teams. The health boards have seen what happened in England and Wales when contracts were given to private companies. They have seen the effect and they want nothing to do with them. Many of them have tried desperately to find a way to in-house contracts.
Even with in-house contracts, it is not as easy as the Minister suggests. The general manager may force further cuts. We had the example less than a couple of years ago of the catering staff in the Royal Hospital for Sick Children and the Queen Mother maternity hospital in Glasgow. There was no bid from a private company. The in-house contract cut the cost. The in-house team cut and cut again, and closed certain things. At the end of the day it was told that the contract would not be accepted until there was a further cut in the cost, although that was the only bid. We are talking not about mass catering for a factory but about the complex diets of sick, young children.
We have seen the impact south of the border when private companies have won contracts. Health boards in Scotland are judging accordingly. Health authorities in England and Wales have had to cancel contracts. Already in Glasgow at the Victoria infirmary the cleansing company has been fined more than £3,000 for failing to carry out its contract properly. The general manager of the company said that he should not have to pay the fine because he thought that he was carrying out the contract properly.
After the company had been fined, the health board gave the contract for portering in five hospitals in Glasgow to the same company. The board did not take account of the incompetence already shown in cleansing at the Victoria infirmary. Having seen that the private company was interested only in the profit that it could make, the board gave it further contracts. A friend of mine who works in the Western infirmary in Glasgow said recently that he saw a new porter from the privatised company waking up a patient to find out where the X-ray department was. That is the portering that hospitals are now experiencing.
With low wages there is a high turnover of staff in privatised companies. I shall repeat a story which I told in Committee of two porters in a lift in the Western infirmary. One said to the other, "Why on earth are you working here for these abysmal wages?" The other said, "Because I am more likely to get another job if I have this

one than if I am trying to get a job from the unemployed register." The chances were that he would not be long in that hospital, that he would never learn the job adequately and that he would never have great loyalty to the health board or the hospital.
Certainly in Glasgow and in Ayrshire and Arran health boards there will be an extension of privatisation. I am talking not about ancillary services but about core services which are essential to the medical needs of patients. The Greater Glasgow health board is considering putting out to private tender the laboratory services and the testing of samples. Companies will come in and take over those services. They will also take over the pharmacies and the control of drugs in a health board area. That seems to be a recipe for high costs as only one drug company will take the contract. Companies might also take over medical records. I agree that in the Greater Glasgow health board area there is a need to improve the handling of medical records. If someone's medical records are at the Southern general and that person has an accident and is taken to the Western infirmary, it cannot be right that the medical records at Southern general are not available. However, to put medical records, with all their confidential information, into the hands of private companies which are operating solely for profit is totally wrong.
Radiography and X-rays are also to be put out to tender. The Ayrshire and Arran board is considering putting dialysis out to private tender. The care of the elderly is also subject to private tender and many of my hon. Friends will refer to that in greater detail. However, there will be a great deal of privatisation and there will be great changes with the opting out of hospitals.
The Opposition would prefer the Health Service to remain a service based on caring for patients and one that provided the health care that we believe should be provided. We are intent on delivering that kind of Health Service. We do not believe in making the Health Service a commercial operation, although the Minister obviously does. If the Minister insists on following that path, we insist that the care should be monitored in Scotland, and the clause would provide that monitoring.

Sir Hector Monro: I listened to the hon. Member for Glasgow, Cathcart (Mr. Maxton) with great interest. He gave us a broad brush account of the Health Service in Scotland, but did not give us much information about what his proposed monitoring commission would do. When we set out the structure of the Health Service in Scotland under the National Health Service (Scotland) Act 1972 we adopted a one-tier system that became the envy of the United Kingdom because England and Wales adopted the two-tier system. It would be a great pity if we added another layer of bureaucracy to a system which, in general, is working very well. With the assistance of the hon. Member for Aberdeen, North (Mr. Hughes), the Standing Committee on the 1972 Act included in the legislation the health councils and the Parliamentary Commissioner for Administration. Those are two good checks on failure within the area health boards. It is unnecessary, given those two checks, to have the additional bureaucratic monitoring system suggested by the hon. Member for Cathcart.

Mr. Robert Hughes: Is the hon. Gentleman aware that the number of local health councils has been reduced drastically and they have to cover much wider areas?


Therefore, the checks and balances to which he referred so flatteringly have been cut severely and that cannot be good for patient accountability.

Sir Hector Monro: Actually, I was just coming to the health councils——

Mr. William McKelvey: Ah!

Sir Hector Monro: The hon. Member for Kilmarnock and Loudoun (Mr. McKelvey) may groan away. I have been speaking for only two minutes. The hon. Member for Cathcart spoke for about 40 minutes. It would be a bit rough for me to have to make my speech in two minutes.
The hon. Member for Aberdeen, North made an important point about the health councils. Their duties are laid down specifically in the 1972 Act and they were to monitor the work of the area health boards. I am afraid that many councils seem to have undertaken operations that are far more extensive and far beyond the scope of what they were originally set up to do and, because of that, they have lost a lot of the influence and power they should have had, as laid down by that Act.
The hon. Member for Cathcart was quiet about costs. Inevitably, it would be expensive if the plans set out in the new clause were to be fulfilled. A fairly effective scientific back-up would be needed to monitor all the schemes that the hon. Gentleman feels are worthy of investigation.
The new clause is a major criticism of the area health boards. Of course, they do not run as effectively as everyone would wish, but, by and large—I can speak mainly of the Dumfries and Galloway health board in my area—they run effectively. As the constituency Member, I deal with that board and, indirectly, with Glasgow, to which several patients from Dumfries have to travel. As my hon. Friend the Minister knows—and will know again tomorrow when he receives another letter—I have some criticisms of the working of the Glasgow board and the staff under its jurisdiction. However, by and large, I should be happy to leave the decision about the quality of the Health Service in Dumfries and Galloway to the area health board itself. After all, that is why its members are appointed. Their prime duty is to ensure that there is an effective Health Service and that the administrative and medical staff provide the highly efficient Health Service to which the constituents of Dumfries and Galloway are entitled.
The Minister knows that I have never been the world's greatest enthusiast for the privatisation of individual aspects of the Health Service or of self-governing hospitals. I very much doubt whether the Dumfries and Galloway royal infirmary will ever become self-governing, but I accept that the procedures for competitive tendering have had an important impact on the Health Service. I have always welcomed the fact that in Dumfries and Galloway the in-house bids have won on each occasion and I have supported the health board to that end. My goodness, many hundreds of thousands of pounds have been saved, which have gone directly to patient care, which is the prime objective of the policy of my hon. Friend the Minister.
The poll that was held in the Health Service last year showed that patients were satisfied with the quality of medical care under the health board. All the proposals in

the new clause should be carried out effectively by the health boards themselves. We do not need another monitoring body, which would inevitably cost a great deal of money, without any guarantee that it would show up faults of which the health board was not already aware and for which remedies were not already in place.
The hon. Member for Cathcart rightly praised the Health Service for the team spirit that it engenders. That is right. The medical, domestic and administrative staff must all work together with the common objective of providing the very finest Health Service possible for the patients in the area. From my experience, I believe that that is exactly what happens.
I believe that, because we have the structure provided under the 1972 Act, it would be unfortunate to bring in another layer of management, or—some would say—of interference, when the work is being carried out effectively at present. There are enough checks and there is good administration and effective management. Because of that and because my hon. Friend the Minister channelled additional resources well above inflation into the Health Service this year and last year, we have been able to increase extensively the number of hospital buildings and other facilities during his period of office.

12 midnight

Mr. Kirkwood: I have listened carefully to the hon. Gentleman's argument. He is skirting round the crucial aspect of the change introduced in the Bill. He and I know that in our areas the area health boards provide a perfectly acceptable service. The new clause has been introduced because the new competitive element introduced into a rural area will make quality much more difficult to attain. What representations has he had from his health professionals about whether the new competitive, free market approach in the Bill will affect the local health service?

Sir Hector Monro: The hon. Gentleman is putting into my argument something that I did not argue. I have had extensive consultations and, like all hon. Members, a large mail bag in the past 12 months. Many people were full of foreboding that the Health Service would be a shambles. Here we are 12 months later and the Health Service is rather better than it was 12 months ago. In 12 months' time it will be better still and 12 months after that better still again. Opposition Members are full of forebodings that misrepresent what my hon. Friend the Minister and my right hon. Friend the Secretary of State are doing to make the NHS better.
I accept that, as the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) said, we have good area health boards and good general hospitals. But that does not mean that that is the case throughout the country. Certainly it is not the case throughout the United Kingdom. I hear stories about hospitals in urban areas where a great deal needs to be done. [Interruption.] Does the hon. Gentleman wish to intervene?

Mr. Kirkwood: I simply wish to quote to the hon. Gentleman the well-known adage, "If things ain't broke, you don't need to fix them".

Sir Hector Monro: I did not catch the hon. Gentleman's point.

Mr. Kirkwood: There is nothing wrong with the area health boards, so they do not need to be reformed.

Sir Hector Monro: The hon. Gentleman is champing away. He will have plenty of time to speak. I am speaking against the new clause which will make it much more complicated and more expensive to provide a high-quality Health Service. I do not want the change suggested by the new clause. It will not add to the effectiveness and efficiency of the area health boards.

Mr. Maxton: The point is that it is not me or the new clause that suggests change. It is the Minister and the whole Bill that suggest changes. The Minister is suggesting change by privatising the services. All I suggest is a relatively minor ability to monitor what is happening with all the changes.

Sir Hector Monro: No. In the new clause, the hon. Gentleman is creating a completely new structure to monitor what is happening not only now but in the future. That is completely unnecessary. If the area health board is not doing its job, will it need to be monitored by another extraneous body such as the TUC?

Mr. McKelvey: If we had a Select Committee on Scottish Affairs to monitor the activities of the health boards, perhaps the new clause and others would not be necessary. My hon. Friend the Member for Glasgow, Cathcart (Mr. Maxton) is correct. The new clause has been tabled to compete with the Government's clause. They want to introduce a new health board which has an overseeing role and will be given extensive powers by the Government. If we do not need the overseeing group, we do not need the new health board. It would probably solve the problem if some Conservative Back-Bench Members would get off their backsides and serve on a Select Committee on Scottish Affairs which could consider such affairs.

Sir Hector Monro: The hon. Gentleman could have spent a few hours in Standing Committee to help balance things up. I will not rise to his challenge about the Select Committee. He knows as well as I that all the Select Committee's reports over the umpteen years produced singularly few results, particularly the report on the NHS. [HON. MEMBERS: "Why"?] I do not want to be diverted from the issue before us. New clause 2 is wholly unnecessary, wholly bureaucratic and highly critical of the management of the area health boards, and I am not prepared to accept it.
My final point relates to renal dialysis units and the Minister will know what I am about to say. I think that Dumfries and Galloway will have these units soon. They must be spread much more evenly geographically. It is intolerable for some of my constituents—I accept that they are few in number—to have to travel to Edinburgh or Glasgow weekly and sometimes more frequently for renal dialysis, especially when we consider the cost and discomfort of trailing up and down the A74 to Glasgow or over the Beef Tub to Edinburgh. Even if we could come to an agreement with Carlisle, I should prefer to see a renal unit in Dumfries to serve those west of us through to Stranraer. I have received optimistic notes from the area health board that one will be established, with luck, this year. I should be grateful if my hon. Friend the Minister could add some ministerial pressure.
The new clause is unnecessary and I hope that the Government will oppose it.

Mrs. Margaret Ewing: I wish to speak to amendment (a). I am extremely grateful to the hon. Member for Glasgow, Cathcart (Mr. Maxton) for his courteous acceptance of the amendment, which I suspect he gathers would tighten the proposals in the new clause.
My colleagues and I believe that it is essential to have a quality control commission to monitor standards in the Health Service. We shall support the proposed new clause, but we wish to see included within it a statutory right to have an annual review because we are in no doubt that the Bill represents a fundamental push towards private medicine in Scotland. It also moves towards the integration of the private sector with the NHS and the creation of a two-tier system. Additionally, there appears to be a secondary objective in the Minister's intentions, which is to break existing powers within the NHS—organisations such as the British Medical Association, the trade unions, the royal colleges, the health boards and, in England and Wales, the regional health authorities.
The hon. Member for Tayside, North (Mr. Walker) seems consistently to object to the use of the phrase "opting out" and prefers "self-governing". It would be more interesting if he would use self-government for Scotland, not just for schools, hospitals and bus companies, for which he is prepared to push firmly.

Mr. Bill Walker: I am perfectly prepared to agree that if more than 50 per cent. of Scots elected more than 50 per cent. of Scottish Members for a party that wanted independence, we would find it difficult to prevent that. The Scottish National party must get that share of the vote before its members can talk to the House about that.

Mrs. Ewing: I am interested to note that the hon. Gentleman referred to 50 per cent. of Scottish voters. It seems he also wishes to change the normal majority rule which has been accepted as a mandate for changing a Government. I will leave him to think that over, and no doubt colleagues in other parties will wish to discuss in detail with him propositions for proportional representation.
Returning to the issue of opting out, the Bill offers the possibility of a fragmented Health Service in Scotland. in which planned development will be impossible. If money follows patients, one hospital's gain is potentially somewhere else's loss. We seem to be moving towards a competitive, devil-take-the-hindmost attitude with hospitals and doctors touting for patients, as they do in Germany.
I shall give hon. Members some idea of what happens in Germany, because it is one of the most realistic comparisons that we can make. No doubt the Minister will point out that there are no waiting lists and no shortages, and that they do not run campaigns for scanners in the German health service. They spend more and they get more than the NHS—more pacemakers, more bypass operations, more investigations and more drugs. It is a competitive system, and therefore, according to the free-market thinkers on the Conservative Benches, it should provide value for money.
Payment is by item of service in Germany. There is competition between the various health insurance companies—which are non-profit making—and between the different health care providers, such as general


practitioners, specialists and hospitals. There is competition not only between hospitals and between specialists, but between hospital and specialist, and specialist and GP. As a result, the different layers of the service compete rather than co-operate. They are trying to outbid each other and to hang on to the source of finance—the patient—for as long as possible rather than co-operating to ensure the most appropriate treatment.
Communication between hospitals, specialists and GPs is dreadful because each hoards its own information and that leads to expensive, wasteful and sometimes dangerous duplication of investigations, and in some cases to over-treatment. It is a tremendous temptation to pander to the perceived wishes of patients—to give them what they want so that they do not go elsewhere. Doctors hesitate to give unwanted advice in case the patient finds a more agreeable doctor.
The system is wide open to abuse. Health insurance companies, which are also in competition, try to reduce the costs of the system. They have imposed contracts on hospitals and limits on some specialist investigations and have alienated themselves from both doctors and patients.
Within the flashy new hospitals in German towns and cities, and the expensively equipped doctors' surgeries, the atmosphere is unhappy and disillusioned. Patients distrust doctors, suspecting that the commercial interests of doctors and insurance companies are influencing clinical decisions. The doctor is not candid with the patient, doctors and hospitals distrust each other, and everyone distrusts the insurance companies. All are entangled in a vast web of regulations, restrictions and demands. An enormous bureaucracy is required to keep track of the patients as they move about the country, change companies, and change doctors. It also has to cope with changing contracts with hospitals, and with different restrictions, and to try to ensure that there is no fraud.
If that is the kind of health service——

Mr. Deputy Speaker: Order. I find it difficult to relate the hon. Lady's remarks to the new clause and the amendment.

Mrs. Ewing: I am trying to exemplify the kind of system that I believe will require monitoring if the legislation becomes law. I am trying to point out the sort of problems that exist elsewhere, why we need a quality monitoring commission as proposed in new clause 2, and why it must undertake annual work. We are being pushed towards the type of health service which the free-market thinkers want, without consultation with those people who are most directly involved.
I have referred to some research undertaken by practitioners in Scotland, by people who are directly involved with the Health Service and who have spent considerable time studying examples elsewhere. My party believes that there should be a comprehensive Health Service which is freely available to all at time of need. We do not seek a two-tier system in Scotland, which would be contrary to the egalitarian ethic which is so important to Scottish life.
The Government are not taking seriously the request that their proposals should be monitored. The hon. Member for Aberdeen, North (Mr. Hughes) has already referred to the fact that the number of health councils is to

be reduced. The local health council in Moray will probably be abolished; it will be subsumed within a Grampian health council. Moray is a separate administrative unit of the Grampian health board. A local health council is therefore needed. If local health councils are to be abolished, it is important that there should be a national body to monitor the changes and their impact on the delivery of health care to the people of Scotland.
New clause 2 is worthy of support. No doubt the Minister will reject it. He prefers his own appointees and his own health boards. An organisation such as this, which would be representative of corporate organisations in Scotland and of Scottish public opinion, ought to be enshrined in legislation. I hope that hon. Members will support new clause 2 and amendment (a), which proposes an annual review.

Mr. Bill Walker: The hon. Member for Moray (Mrs. Ewing) has wandered down an avenue that I do not propose to enter. She has compared the Health Service in Scotland with the service that is provided in Germany. I agree with my hon. Friend the Member for Dumfries (Sir H. Monro) that the Health Service throughout much of Scotland is splendid. I can speak with authority only about Tayside, where the service is probably second to none anywhere on this planet. That is quite a statement to make.
The hon. Member for Glasgow, Cathcart (Mr. Maxton) drew attention to the fact that I spent a long time in hospital. Yes, I did, following an accident. However, he has probably forgotten that not long ago I spent some time in a hospital in Dundee, at the same time as the hon. Member for Dundee, West (Mr. Ross). We were in the same ward. He would probably confirm that the quality of service that we received, not because we were Members of Parliament but because we were ill and required attention, was splendid. That does not mean that we do not wish to improve the Health Service. As new techniques, skills and operations become available we want them to be available in our area.

Mr. Maxton: I believe that the hon. Gentleman was in hospital in Dundee in the late 1970s and early 1980s before all the Government's reforms. He has described it as a wonderful service. Why on earth, therefore, has he constantly supported the Government's reforms?

Mr. Walker: The hon. Gentleman's memory is flawed. I was in hospital just before the general election in 1979.

Mr. Maxton: I said the late 1970s

Mr. Walker: I was in a hospital where there were no disputes. That is important when one remembers the period in question. The staff at Stracathro hospital were absolutely splendid and superb. They were not involved in any of the disputes that were taking place elsewhere. I make no issue out of the absence of dispute. I was also in hospital two and a half years ago—not too long ago, by anybody's standards.
The hon. Member for Cathcart repeated in his speech what we heard so often in Committee—his views on competitive tendering, privatised services and in-house tendering. However, the new clause talks about
(a) establishing the standards that shall be met by
Health Boards in carrying out its functions.
I imagine that all health boards, in carrying out their functions, have to deal with a huge element of what could


be described as clinical activity, yet the hon. Gentleman, in nearly 40 minutes' chat, did not mention clinical standards once. In those very narrow specialist areas, who will monitor standards? The hon. Gentleman and I both know that it is health boards that have the people to do so. As my hon. Friend the Member for Dumfries said, the appointment of people throughout Scotland for that purpose would amount to the creation of an unnecessary tier of bureaucracy.
The hon. Gentleman did not really intend that clinical standards should be covered—at least that is the impression that his observations conveyed to me. Thus, it seems, this new clause, with an amendment in the name of the hon. Member for Moray, is designed to deal with privatisation, competitive tendering and in-house tendering. If that is what the hon. Gentleman intended he should have made his new clause much more specific and much clearer. In fact, the new clause covers every area of activity with which health boards deal. It says that the commission's responsibilities will include
where any services have been put out to competitive tendering, ensuring that the standards of that service are maintained".
I accept that, but
carrying out investigations from time to time to ensure that such standards are being met
is another matter. Those are the words of paragraph (b)
Paragraph (a) says that the commission's responsibilities will include
establishing the standards that shall be met by Health Boards in carrying out its functions"——
[Interruption.] The point I am making, which Opposition Members find frivolous, is that, according to the way in which the hon. Gentleman has drafted and presented his new clause, this body would monitor every single activity of all health boards throughout Scotland. The cost of meeting the statutory requirements laid down here would be horrendous. If the hon. Gentleman is minded to tell me that that is not what is intended, let me make it clear that it is what the new clause spells out. Paragraph (d) says that the commission's responsibilities will include
where such services are not maintained, to instruct the Health Board to take such action as they consider necessary".
The hon. Gentleman mentioned pharmacy. It is astonishing to suggest that pharmacists, of all professionals, are unable to do inside hospitals the work that they do in their shops. Indeed, most pharmacy is privatised. Is it suggested that the pharmacy service that we in Scotland enjoy through chemists' shops is not up to standard? That is what the hon. Gentleman is suggesting.
The hon. Gentleman went on to other areas of medical activity, such as X-rays and dialysis. In my view, this new clause typifies the hon. Gentlman's prejudice against anything to do with privatisation or competitive tendering. We saw that in Committee, and it comes through every time.

Mr. Maxton: The hon. Gentleman's idea is that we cannot have an inspectorate to investigate standards. There is no question of every hospital or every element of the Health Service being investigated annually or at some other interval. As with schools, factories and a range of other places in which there are inspectors, it is a question of attempting to ensure that standards are met. I realise that the Government do not like such arrangements. The hon. Gentleman may not like them, but they are there. Why should not arrangements that exist in many other areas apply to the Health Service, too?
Labour Members are not constantly showing their prejudices. The Government not only show their prejudices but impose them against the wishes of the majority of the people in the United Kingdom. They put those prejudices into legislation.

Mr. Walker: I drew attention to the all-embracing, expensive proposals in the new clause because the hon. Gentleman accepted without hesitation the amendment tabled by the hon. Member for Moray which requires this review to be carried out annually. Having accepted the amendment, the hon. Gentleman must accept that he was trying to put into law the requirement to carry out an annual review at all levels in every sector of the Health Service. He now says, "We want to qualify that. We want a system of monitoring on an ad hoc basis." That is exactly what the health boards do now, so we do not need this nonsense.
If the hon. Member for Cathcart says that we all want a Health Service that operates as effectively and efficiently as humanly possible, none of us will argue with him. A statutory requirement to set up a body to police annually every sector of activity of the Health Service in Scotland would be a recipe for printing money, which would have to come from the taxpayer. The taxpayer would much rather the money were spent on new hospitals and on other such provisions. That is exactly what the Government have done, unlike any Government whom the hon. Gentleman would like to see in power.
One must be judged by what one does. The damage sustained to the Health Service under the previous Labour Administration is our only measure of what would be likely to happen in the future. We would end up with an expensive bureaucracy. The money would be better spent on health care. That reasoning lies behind the Government's thinking and that is why I hope that my hon. Friend the Minister will throw out the new clause.

Mr. Robert Hughes: I am grateful for the opportunity to take part in this debate, which takes place against: a background of changes in the Health Service in the past and those that are about to occur. The hon. Member for Dumfries (Sir H. Monro) said that the Health Service was better than it was 12 months ago and that the dire forecasts of the damage that would be caused by the Government's changes have not been fulfilled. Of course, they have not, because the changes have not taken place. Opting out of self-governing hospitals and general practitioner budgeting have not yet occurred.
Before the current health boards, there were regional health boards and, below them, special hospital boards dealing with children, the mentally ill and other areas. There were different levels of involvement by people in the lay administration of the Health Service. We were worried that under the new health boards far fewer people would be involved in that lay administration. The argument for many of the changes was that the system was too disparate, clumsy and bureaucratic, that too many people were involved, and that there was no proper administration.
I do not pretend that the old system was perfect. I can give ample examples of specialist hospital boards not carrying out their functions effectively. I do not argue that we should return to that system. Many took the view that there has to be lay accountability and the involvement of ordinary people who were not medical specialists, but who


had a great interest in the Health Service and were willing to ensure that the different functions in patient care were carried out. There was a strong feeling that that link with the public was being weakened, so the local health councils were brought into being.
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People's experience of local health councils varies from area to area. No area in Scotland could say that everything was lovely and that there was a perfect relationship between the local health council and the area health board. Equally, no area in Scotland could say that its local health council was a complete disaster. I shall not be thanked for this by people who have done a great deal of work in local health councils, but I must say that my judgment is that they have not been as effective as they should have been in monitoring patient care and the way in which the health boards have carried out their responsibilities. They have not been particularly effective in discussing with health boards changes and plans for the future. However, it is a retrograde step to cut down the numbers.
As I am sure that the Minister will remind us, after an independent investigation, the proposition was that all local health councils should disappear. It is worth putting on record our appreciation of my hon. Friend the Member for Strathkelvin and Bearsden (Mr. Galbraith) and of the Minister. I know that my hon. Friend the Member for Strathkelvin and Bearsden went to see him to tell him that it was a mistake to do away with all local health councils. We now have a compromise, which is better than nothing, although I have had a letter today from my local health council saying that it is very disturbed that there will be one local health council for the whole of the Grampian region and that there will be insufficient representation for matters to be covered properly.

Mr. Michael Forsyth: The hon. Gentleman is being very fair. Will he make his own position clear? The position of the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith), as the Front-Bench spokesman, was that he favoured moving towards having one health council for each health board area, with the possible exception of areas such as the Highlands. The general principle was to move towards one health council per area. I had the impression that the hon. Gentleman did not support that.

Mr. Hughes: In the absence of my hon. Friend the Member for Strathkelvin and Bearsden, I must say that if his position is that there should be, generally speaking, one local health authority or its equivalent to cover the whole health board area, except in remote areas, I respectfully disagree. However, there is no dishonour in that and it is no reflection on my hon. Friend, who, as we know, is unable to be with us in the debate. I am expressing a personal judgment. I am unhappy about the proposition to have only one local health council per health board. Whether we have two is a matter of judgment, so these matters must be considered in terms of individual areas.
I do not want to be diverted down this path for too long, although it is relevant to the debate on the quality control commission but there is a great difference between the city of Aberdeen, which is fairly densely populated and has highly sophisticated facilities at the hospitals, and the constituency of Moray, where the facilities could not be

expected to mirror what happens in the inner cities. However, because of the differences of population and psyche between city dwellers and those who live in rural areas, we should have local health councils covering different areas, a different geographical spread and a different range of interests. I hope that, as the matter has arisen sharply in this debate, the Minister will reconsider the matter and where we go from here.
A quality control commission is necessary. The Mental Welfare Commission is already in existence. It oversees the welfare of patients in mental hospitals. The people who have served on that body over the decades have done a splendid job. On the few occasions when I have found it necessary to raise cases with that body, my inquiry has been dealt with fully and I have always been satisfied with the result. It is a comfort to have that commission in place so that complaints about the way in which patients have been treated can be followed up. I understand that the commission does not deal with clinical matters, so that one cannot refer to it complaints about the clinical treatment of patients.
We are moving to the time when patient care will be dealt with at one stage removed from the direct control of area health boards. That will particularly be the case with private nursing care, especially of geriatrics, which normally would have been done as a matter of course by the NHS. That type of activity will gradually be done more and more by private industry.
I wish to relate the details of a case, but I will not give the name of the private nursing home because the circumstances involved have been taken care of and I would not want to malign the present management of the home. A blind constituent raised with me problems concerning the care of the residents and the conditions at and services provided by the nursing home. The health board was aware of the case because complaints had been made directly to the board. The matter was taken up with the owners, who changed the management, and conditions have improved.
In addition, my blind constituent believed strongly that the lack of care of her husband led to his premature death. I raised that serious allegation with the health board and received a letter in reply at the beginning of December saying that an investigating officer would visit my constituent and discuss the issue. I appreciate that grave matters of that sort take time to be investigated. I was not surprised when two months went by and I received no further correspondence. At the beginning of March, when going through my files, I thought it was time I gently prodded to see what was happening.
I wrote in mild terms saying that I had been told at the beginning of December that the issue was being investigated, that I had heard nothing further and that I would like a progress report. I was astonished to receive a letter today, signed pp, for and on behalf of someone else, by somebody in an area unit—not by the chairman or secretary of the board, not by a chief medical officer and not by the area health board manager—saying in four or five lines, in effect, "We can confirm that an investigating officer saw your constituent who, following discussions, is now satisfied. Yours sincerely."
That is not acceptable to me. The health board should at least have had the decency and courtesy to let me know that the matter had been dealt with. I will willingly let the Minister have the letter, which I have not quoted. I am more than pleased that my constituent is satisfied, but the


issue seems to have been dealt with in a ham-fisted way. A serious allegation was raised by a Member of Parliament, who did not receive a proper explanation or even a courteous reply.

Mr. Michael Forsyth: If the hon. Gentleman will let me have the correspondence, I will investigate the matter. I confirm that when Members of Parliament write to health boards, I would expect them to receive a reply from the chairman or general manager of the board explaining the position. It is difficult for me, without knowing the circumstances of the case, to respond, but I apologise to the hon. Gentleman and will follow up the matter if he will give me the necessary correspondence.

Mr. Hughes: I thank the Minister. I have not yet dictated my reply; I was about to fire it off on my word processor, but then I realised that if I did that I would burn out the works, so I decided to wait until tomorrow and dictate it to my secretary. I shall be sending a letter to the chairman of Grampian health board, anyway.
During my investigations and my discussions with the board, I established that, although it has a responsibility to license private institutions and to monitor their general operation, it has absolutely no responsibility for health care in such institutions. The responsibility for health care clearly rests with individual GPs. Although they will of course do their best, we all know what a GP's life is like. Even when a patient is living at home, he or she—from now on I shall just say "he", because at this time of night I shall not remember to say "he or she" each time; I hope that the hon. Member for Moray (Mrs. Ewing) will not take it amiss—does not have time to look at his list and say, "I have not seen Mrs. Smith for a couple of months. I had better see how she is getting on." He has not time to visit private health-care establishments to check on the quality of care; it is up to the management to call in the doctor if it is thought necessary. I feel that there must be a closer check, whether through a quality control commission or through some other machinery.
The control of clinicians and clinical judgment is an issue with which we have wrestled for as long as we have had health legislation. Who controls the medical profession? By and large, it controls itself. I served for some time on the General Medical Council, as a lay member, and I am bound to say that its specialists do an extremely good job. My one quarrel with them is that they always seemed to deal with allegations of negligence less severely than with allegations of sexual misconduct. The GMC being an open forum, the press turned up in droves if there was an allegation of sexual misconduct; they filled the GMC press gallery. If the question was whether a doctor had gone out to visit a child at night, however, they were not so interested. I am not saying that the medical profession was uninterested in such cases, but it seemed to me that it was harder on allegations of sexual misconduct than on those of possible clinical misjudgment. Clinical misjudgment is dealt with, in one way or another, by the medical profession. Lay people find it difficult to deal with. There is a gap at present, which my hon. Friends and I have sought to fill in debates on various health Bills.
Let me cite another case from my constituency. Again I shall not name names, although the Minister will recognise the case from correspondence that he has received from me. My constituent suffered from obesity. She underwent a form of surgery whose medical

description I can never pronounce. Essentially, it means that the stomach is closed up for a period, leading to a loss of appetite and consequent weight loss; the operation is then reversed and the patient should be able to function normally. In this case, however, the woman was extremely ill and could not keep food down. When she went to see the doctor and other hospial staff, they all said, "It is psychosomatic. Nothing has gone wrong with the operation; you should see a psychiatrist." That did not help her—indeed, the hospital did not provide a proper psychiatric counsellor. I am advised that that operation should not be done without pre-operative and postoperative psychological counselling so that people know what to expect. All the papers in the case confirm that.
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My constituent went through sheer hell. Her weight went down to between 5½ and 6 stones. Luckily, she discovered by accident that the surgeon who had done the operation had moved to another hospital in the Grampian area, so she was able to go to see him. As soon as he heard her symptoms, he said that there was something very wrong. She was examined and it was discovered that the operation has not been done properly. Fortunately—or unfortunately—my constituent is now back to her previous gross weight. However, she went through a difficult period.
Such an investigation can go down only two roads. First, there is the pure investigation within the Health Service. If a patient is dissatisfied with that investigation, the only alternative is to take an action in court for negligence, and that is about the most difficult thing that can be done. First, an independent assessor is appointed. He is a doctor, and I make no complaint about that.
The doctor decided that my constituent was badly advised psychologically, that the operation was done wrongly, and that she should have been examined more carefully when the problem developed. But he still came to the conclusion that there had been no negligence. That very statement immediately cuts out the possibility of an action in court because in such a case the legal aid board in Scotland will not provide legal aid. A particular case sets out the test, but basically it says that there must be a reasonable chance of the action succeeding. As long as an independent medical assessor says that there is no negligence, there is no legal aid, and the case stops.
In that position, all that I could do was to write to the Minister and ask him to set up an independent inquiry because the same operation had gone wrong in other cases in other parts of Scotland. I do not criticise the Minister. He replied courteously and pointed out that this was a highly speculative operation which should be done only as a last resort with the greatest of care and preparation. But he would not set up an independent inquiry.
A patient who is dissatisfied with the Health Service and the in-house medical report and wants the matter to be looked at again has no means of doing so. There is no commission and the Minister will not have an inquiry. What on earth can happen next? This is only one example of dissatisfaction. There are many other examples.

Mr. Bill Walker: The hon. Gentleman will know that the Health Service Commissioner investigates all areas other than clinical judgments. I accept that he cannot comment on that aspect. I spent some years as a member of the Select Committee on the Parliamentary


Commissioner for Administration and aspects of the case described by the hon. Gentleman seem similar to cases that have come before the Health Service Commissioner, have gone to the Select Committee and have been dealt with in a way with which the hon. Gentleman would be pleased. That is a course that the hon. Gentleman should consider because, if nothing else, the Health Service Commissioner will look at the handling of the administrative aspects of the case and if there has been any maladministration it could well form a ground on which his constituent could decide whether to take action.

Mr. Hughes: I appreciate that the hon. Gentleman is intending to be helpful. I shall certainly look again at the case papers. However, this matter should not go to the Health Service Commission for Scotland because it is outwith its remit. I certainly would not want to give a constituent hope. I do not believe that one should simply palm off a constituent by saying that one is going to send on his complaint to a certain place, and so get rid of the problem. I shall see whether there is a possibility of sending it.
I am sure that all hon. Members could quote other examples involving clinical care, as I could. We should look at this matter. The new clause states that one of the commission's responsibilities would be
To investigate complaints from patients in regard to the Health Service, and take such action as seems appropriate.
That would cover the possibility of looking at clinical judgment. I would be prepared to allow the medical profession to take part in such an exercise, act as monitor and referee and give guidance.
However, there is a big gap at present. The gap between the perception of patients about how their complaints are examined and the reality of what happens is likely to get wider because the privatisation of the Health Service is moving apace, to the extent that before legislation is passed health boards are examining services which they want to put out to tender.
It is grossly wrong for Grampian health board to be looking at the possibility of a new 60-bed unit which is being built and should be open already. It is to be open temporarily to tide the health board over while it deals with a clinical problem. The full clinical care, from beginning to end, in that unit is to be put out to private tender. Apparently, the board is to consider an in-house offer. I do not know how there can be an in-house offer when there are no consultant psychiatrists, consultant geriatricians, nurses or managers in place, so I do not know how there can be the possibility of an in-house team when there is no in-house team to put in a tender.
My hon. Friend the Member for Aberdeen, South (Mr. Doran) and I went to see the chairman of the Grampian health board, Mr. Kyle. I expected the chief administrative medical officer to be there, not the unit manager. I found that offensive. It was clear that the discussion was driven by the unit manager. Even more impertinent was the fact that one functionary, a paid employee of the health board, not a board member—I could take it from a board member—had the temerity to criticise my hon. Friend and me in public for daring to question the health board decisions before they had been taken. In other words, Members of Parliament are supposed to wait until decisions are taken by bureaucrats, or even the board, and

are then brought into consultation. That is quite unacceptable, and that has been made plain to the health boards.
Entire hospitals, as full separate units, will be handed over to private enterprise, with no mechanism for checking what goes on. If the new unit goes over entirely to a private company, who will be responsible for the medical treatment and conduct within the new unit? Will it be a parallel position to that of the private nursing homes that I mentioned earlier? They are licensed by the boards, which have overall responsibility to ensure that they are run reasonably well, but the patients' clinical care will not be the health boards' responsibility.
The Minister must address himself to that issue. If the whole exercise, from consultants to nurses, is done by a private company, who will have ultimate responsibility for the health of the patients and ensuring that their clinical treatment is met absolutely? I would prefer it if none of the new clause was necessary, although there are gaps here and there that should be closed, even within the Health Service, as a matter of public administration. We must look at this issue clearly. A quality control commission would be worthwhile.
Although my hon. Friend the Member for Glasgow, Cathcart (Mr. Maxton) may not have every dot and comma right, the concept is worth pursuing because the Health Service is important. I shall go even as far as to say that, although I do not like large numbers of them, there is a place for business men on the area health boards.
However, the best way to achieve a public Health Service in the best tradition of looking after patients must involve the public in the widest sense. That involvement is shrinking each year and the Health Service is becoming more specialist, both in clinical and managerial areas, which is bad for the development of health care. A quality control commission would go a long way towards mitigating the effects of present practice until such time as we could restore the NHS to the full public ownership, full public participation and full public provision that the people want.

Mr. Thomas McAvoy: I am aware of the late hour, but I have waited for some time to be called to speak and I hope that my tired and weary hon. Friends will bear with me. They will be even more weary by the time I finish.
A quality control commission for the National Health Service in Scotland would be invaluable, especially as its members would be appointed after consultation with a wide spread of Scottish opinion. It would play a vital role in establishing the standards to be met by health boards. My constituency would provide such a commission with just the circumstances in which to set standards to be met by the health board. The conduct of Greater Glasgow health board in its secret negotiations with Takare plc, involving the privatisation of care for the elderly, has been nothing less than disgraceful.
The necessity for a local geriatric hospital has been recognised by health boards for a number of years. It is intolerable that residents of Cambuslang and Rutherglen should have to go to Cleland hospital for geriatric services. There is considerable difficulty and expense for visiting relatives. A more convenient location would ease the problem, with the added bonus for both patients and


relatives of additional visits because they would be easier to undertake. It is a reflection on Greater Glasgow health board that that indisputable need was not made a priority.
I am aware that the health board had, and still has, difficulties with capital and revenue funding, but the need in Cambuslang and Rutherglen is longstanding and should have been dealt with. I am sure that a quality control commission would ask the health board why, if it was committed to providing care for the elderly in Cambuslang and Rutherglen, it initiated discussions with Takare plc.
I wish to quote from an extract from the Greater Glasgow health board report of its annual meeting with the south east local health council on Thursday 1 May 1986. Mr. Macquaker, the then chairman of the board,
"revealed that the Final Cost Limit, £7,845,500 had been approved by the Scottish Home and Health Department.
However, the report suggested that there might be a problem because of the revenue consequence of £1,208,445. Therefore, in May 1986 permission was given for the hospital and the capital costs were made available. Yet the board is proposing to take on the revenue costs of 180 beds with Takare plc, with a charge of at least £230 per week, and the signs are that the figure will be considerably higher. That amounts to more than £2 million of revenue at just that one location. Although the board said four years ago that it could not afford £1·2 million, it is giving over £2 million to Takare.
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The behaviour of the board should be scrutinised carefully. I am a strong supporter of a quality control commission which would subject the board to a statutory examination of its activities. In its own documents about the proposed privatisation of elderly care at Rutherglen, the board stated that there should be consultation with the local regional council. Yet no attempt was made to consult the regional council, as the major provider of other aspects of care for the elderly, about Takare. That goes against the board's own policy and is an indication——

Mr. Michael Forsyth: I want to be clear about this. Is the hon. Gentleman saying, as the constituency Member for Rutherglen, that he is opposed to a new facility being provided for elderly people in his constituency at no capital cost to Greater Glasgow health board and at less revenue cost than it would cost the board to provide those facilities, even if it was prepared to make the capital available? Is that what the hon. Gentleman is saying?

Mr. McAvoy: As the constituency Member, supported by every community organisation in Cambuslang and Rutherglen, and by all elected Members with the exception of the Liberals, I can tell the Minister that the whole community wants the health board to fulfil its commitment to provide a National Health Service hospital, based in Rutherglen and covering the catchment areas of Cambuslang and Rutherglen.
The Minister talked about finance. I shall deal with the financial aspects of the proposed deal with Takare. It is a bad financial deal for the public, according to information from the chairman of Takare. There are two aspects to my opposition. The whole community wants a National Health Service hospital; in addition, we maintain that this is a bad financial deal for the public.
There is ample scope for a quality control commission to ensure that, when services are put out to competitive tender, the standard of service is maintained. There is a

complication. If a quality control commission was supervising the arrangements that might come into being through Takare, it would have to check whether the competitive tendering that resulted in Takare being awarded the contract was legal. No other company was involved. Where was the great principle of competitive tendering about which we hear so repetitively from the Minister? We are told that in the interests of the patient there should be competitive tendering. Not one other company was invited to be involved in the negotiations. The whole thing stinks.

Mr. McKelvey: My hon. Friend and the House will realise that Greater Glasgow health board is not within my constituency; nevertheless, I am an interested Member. I was appalled at the attitude of the board when we went to see it about the privatisation of the laboratory system. I have not seen anything like it unless we go back 30 years in industrial relations. The board was prepared to ride roughshod over the concerns of Members of Parliament and others. My hon. Friend is right. The one thing that might have brought the board into line was a body such as is proposed in the new clause. I have never seen such a Victorian attitude displayed by any authority for the past 30 years.

Mr. McAvoy: I entirely endorse what my hon. Friend said about the attitude of Greater Glasgow health board. In his intervention the Minister sounded like a parrot mouthing the words of Mr. Peterken. However, perhaps Mr. Peterken is the parrot repeating the Minister's words. I accept that the health board's attitude is disgraceful.
Paragraph (d) of new clause 2 allows the commission
to instruct the Health Board to take such action as they consider necessary
if such services are not maintained. That brings me to the standards of care operated by Takare that would come under the authority of a quality control commission.
I welcome and endorse the principle of moving frail and elderly people who do not need constant medical care out of hospitals. However, I have considerable doubts about what conditions will apply. In what condition would a resident have to be in order to be admitted to a Takare development? Home care environment is referred to in the Takare documentation, but that can mean different things to different people. I have visited Takare establishments at Preston, Chorley and Oldham. The matrons at those establishments confirmed that on average 75 per cent. of the residents were stroke patients and 75 per cent. were also incontinent.
Such conditions did not square with the board's statements about sheltered housing being suitable for the kind of resident in the Takare establishments. The board described the Takare model as nursing care—that might be a back-handed compliment to Takare. However, the care that I witnessed in Takare units goes far beyond what can be regarded as nursing care.
The type of patient that would be established at a Takare development at Rutherglen must be clarified. From what the matrons told me and from what I saw, there seems to be some confusion about that. There should be no confusion about the care of the elderly. We are here because of those people and they should be elevated to the highest position in society.
I visited the Takare developments as a lay person. I reported back that, as a lay person, I made no criticism of


the homes provided by Takare. However, I made it clear that I reserved my position on the application of medical and professional criteria.
I managed to get hold of a report of the Forth Valley health board. I think it came in a plain brown envelope. The health board sent a team of professionals to assess the Takare facilities. The report stated that commodes were kept in residents' and patients' rooms and that there were no en-suite toilet facilities. It stated that, as far as possible, the Forth Valley health board's nursing home inspection team was trying to discourage such practices in nursing homes.
The report states that bathing and toilet areas were rather remote from the main day rooms and were lacking in privacy. It stated that there were no showers and only relatively few assisted baths. It made the professional criticism that there was no structured attempt to introduce health promotion measures in the area. The report confirmed something that I recalled. It stated that there seemed to be a higher number of wheelchairs in use than expected. I recall my quandary as I pondered what kind of resident would benefit from such accommodation.
The report also referred to a strong smell of urine in several, but not all, of the units. The team could not ascertain the cause of the smell specifically. It stated that it may have been due to inadequate nurse-patient ratios. I mentioned that in my submission to the consultation process. The staff worked shifts and a professional view would have to be taken of the system to ensure that that care was the best for the elderly people.
The Forth Valley health board stated that there was no attempt at primary nursing or employing a key worker. As a result, most of the nursing care was task-oriented according to professional criteria, and medical records were poorly designed. It stated that there was no organised database, either current or historical, for the residents. However, the really amazing thing comes in the next sentence, which states:
It is therefore recommended that the Board pursue more detailed discussions with Takare to determine and explore the viability of future joint ventures.
The logic of that escapes me.
I come now to one more sign of the highly political direction that is given to the boards by the Minister. Under para (e) of the new clause, the quality control commission would be well placed to investigate complaints from patients and to take action on them. I am sure that the quality control commission could play a major role in carrying out such investigations to ensure that the standards that have been established are being met by the health boards.
I am also sure that financial criteria would be a key element because we all want value for money, but let us have a close look at this financial involvement. I met an official of the board in September, who roughly outlined the financial arrangements round which the discussions with Takare had centred. When I went down to Takare, I met Mr. Keith Bradshaw, its chairman. Hon. Members might be interested to know that Takare's motto is, "Who cares wins". The House can make what it likes of that.
I spent about eight or nine hours talking to Mr. Bradshaw and his company. He was a lot more forthcoming with information than the board had been. He told me that at that point the discussions with the

board had centred round the price of £375,000 for the land. When I pointed out that the district valuer would have to set the price of the land, Mr. Bradshaw said, "I know that, but that is the price round which all the discussions have centred." I asked how he could work out the deal if he did not know the price that he would be paying. He then told me that if the district valuer valued the land at more than £375,000, Greater Glasgow health board would finance the borrowing costs of the capital that would be required to make up the difference.
The Minister said that this is a good financial deal for the public, but the board is financing the purchase of its own land by a private company. That is what Mr. Keith Bradshaw said to me. I have it on record at two public meetings that were held in Cambuslang and Rutherglen when Mr. Cleary of the health board was present. I challenged the board to refute what I had said, but as no refutation was made, I hope that no one will suggest that what I am saying about my discussions with Mr. Bradshaw is untrue.
I shall give the House an example of where the quality control commission could crack down on financial standards. For every £100,000 over the discussion price of £375,000 that Takare would have to pay, the board would allow Takare to load £18,000 per year on to the total cost of the beds in the unit. The health board official told me that, in his opinion as an experienced person, the land might be sold for between £850,000 and £870,000. That is £500,000 more than the discussion price of £375,000. If the board allowed Takare to load £18,000 on to the total cost per unit for each £100,000 over the discussion price, and as £875,000 is £500,000 over the discussion price, we must multiply £18,000 per year by five, which means that £90,000 per year would be loaded on to the price of the beds for ever. Is that a good financial deal for the public? I do not think so.
That land was owned by the royal borough of Rutherglen. It was public land. The former town council sold it only on the basis that the site would be used for an NHS facility for the people of Cambuslang and Rutherglen. I do not accept that that is a good financial deal and nor do the people of Cambuslang and Rutherglen.
We also need the commission to oversee incestuous relationships such as are envisaged in that deal. The board would be the licensing authority for one of its main providers of service for the care of the elderly. Is that right and proper?
If that is good business for the boards, there is also another complication. The boards have stated clearly that if this private company ran into financial trouble and had to close the week after it opened, the board would simply buy the hospital back under the contract at the going market price. If the board has the money to buy back the hospital from Takare at the market price, why not use the capital to build an NHS hospital in the first place? It is clear to me that the board is politically desperate to go ahead with the deal.
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The people of Cambuslang and Rutherglen, and, indeed, the whole of south Glasgow, are affected not only by the Bill but by serious proposals relating to services at Victoria infirmary. They are causing a great deal of worry in our area. It is wrong that people should be worried about health.
Every time that I go to a meeting with Greater Glasgow health board, I leave feeling that I have been through 15 rounds with a political opponent. That was echoed by my hon. Friend the Member for Kilmarnock and Loudoun (Mr. McKelvey). The boards are supposed to represent, reflect and work for the good of the public. Nobody should leave a meeting with one of them feeling that way. I would make the same criticism if Conservative Members left a meeting with their Labour health board feeling that they had gone through 15 rounds. That would also be wrong. It has happened more than once with Greater Glasgow health board. But a new day is dawning and each opinion poll that is published makes that clear.
In its haste to push the deal through, the board has run into a few problems with the trading conditions for the sale of the land. There is no doubt that in the absence of a quality control commission, the Minister can do practically whatever he wants. Under his political direction, his political puppets on health boards throughout Scotland and certainly in Glasgow are jumping to his tune.
A quality control commission would have asked Greater Glasgow health board several questions. Why was no company other than Takare involved? Why was a ridiculous price for the land set at £350,000 in negotiations with Takare? Why should the board finance the purchase of its own land? Why was no account taken of the responses to the consultation process, which were overwhelmingly against the proposal?

Mr. Bill Walker: Will the hon. Gentleman give way?

Mr. McAvoy: I shall make one more point and then I shall give way. I am sure that the hon. Gentleman will appreciate the point that I am about to make. The only people who welcomed the proposal in the whole of Cambuslang and Rutherglen were not the local Conservative association, but, lo and behold, the local Liberal association. It saw the chance to obtain a bit of kudos, but its welcome backfired. It will pay the price at the regional elections in May.

Mr. Walker: The hon. Gentleman has presented an interesting financial scenario. Does he think that it could properly be investigated by a body that already exists—the Public Accounts Committee of the House?

Mr. McAvoy: I shall certainly consider that suggestion. I shall consult on it. I assure the Minister that the battle is not over. There is a long way to go yet.
The quality commission would also ask why the board was willing to subsidise a private company to purchase its own land. If it is willing to buy the development back if the company collapses, why not use that money to build a hospital?
I am sure that a quality control commission would do a job for the vulnerable and elderly in my constituency by ensuring the highest standards of care for a generation which deserves them.

Mr. Michael Forsyth: I apologise for intervening again. I intervened earlier but the hon. Gentleman did not answer my question directly. I want to be clear about what he wants me to do. Does he argue that the Takare proposal, which will provide a facility for the elderly in his constituency, should not go ahead? Does he want that facility to be provided? Will he answer yes or no?

Mr. McAvoy: If the Minister is asking me what I should like, I should accept his resignation across the Table. I have already made it plain that my community wants an NHS hospital. He can release finance for that to go ahead.

Mr. McCartney: As an English Member, I apologise to my Scottish colleagues for intervening in the debate. I have listened with interest. Yesterday I received an anonymous letter from a representative of private care owners in my area asking me to look into an allegation that a company called Takare was about to get a contract from Wigan health authority, without tendering, to remove mentally ill patients from Billinge hospital in my constituency. I have been asked to investigate why the health authority is involved with a company in relation to such important services without it tendering or consulting. I had no knowledge of the company until this evening when my hon. Friend said that it was alive and well in the Greater Glasgow health board area. It may have some considerable friends at court. Perhaps we can consult about the matter later this morning.

Mr. McAvoy: My hon. Friend's intervention confirms that there is an organised pattern to the company's activities and that arouses concern.

Mr. Harry Ewing: Is my hon. Friend aware that at the beginning of his speech the Minister asked whether my hon. Friend was in favour of this facility at no cost to public funds, but after my hon. Friend had given the cost to public funds the Minister dropped that part of his question? It is significant that the Minister changed his question.

Mr. McAvoy: That was noticeable and I am grateful to my hon. Friend for pointing it out. The Minister is blackmailing Cambuslang and Rutherglen in exchange for future facilities. We know the type of facility on offer. There is no guarantee about what type of service there will be or for how long it would be there. We know the NHS in Cambuslang and Rutherglen. Those are the standards and the hospitals that we want. I serve notice on the Minister that the battle is not over.

Sir David Steel: Without in any way endorsing the details of the new clause, I broadly support its intention, which is to insert in the Bill some measure of concern about the future quality of our NHS in Scotland. I am wholly in sympathy with that objective.
Inevitably, each hon. Member who has participated has spoken about the effect on the quality of the service in his or her area and I shall be no different. It is well known that in the Borders we have the good fortune to have a new district general hospital of which we are proud, although it came 10 years after the date when it was first supposed to be completed. As it is the general view in our area that we have a good NHS, there is great concern that the Government have unnecessarily upset the morale, structure and funding of that service.
Although many representations have been made to the Minister since the Government issued the original consultative paper, his reaction has always been that people do not understand our proposals, give them time, it is all part of a propaganda campaign by the British Medical Association and if only they will study our proposals, listen to our speeches and consult, they will agree. All I can say is that at the end of the process, having


listened to all the speeches and having had a visit from the new business chief executive of the NHS in Scotland, those who work in the service are as worried as they were at the beginning.

Mr. Michael Forsyth: indicated dissent.

Sir David Steel: It is no good the Minister shaking his head. On Sunday afternoon my hon. Friend the Member for Roxburgh and Berwickshire (Mr. Kirkwood) and I were summoned to a meeting by a representative collection of NHS consultants, administrators, GPs and nursing staff. Their overriding message was that they were deeply concerned that the Bill would lead to the fragmentation of an otherwise wholly accepted, well integrated NHS. It is no good the Minister shaking his head. I was at the meeting and he was not.

Mr. Forsyth: I take the point that the right hon. Gentleman has made about what happened at his meeting, but he said that there was as much concern now as there was at the beginning. That cannot be true, because even the BMA has withdrawn the allegation that it made that patients would not be able to get the drugs that they required because of the proposals. To date I have had 28 expressions of interest from doctors who wish to become budget holders. A number of hospitals—[HON. MEMBERS: "How many? Name them."] Four hospitals have shown an interest in self-governing status. The right hon. Gentleman is wrong to suggest that there is the same concern now as there was at the beginning.

Sir David Steel: I was telling the Minister about the mood of medical opinion in the Borders area. I am talking not about public opinion generally, but about the experience in the Borders, where there is a good Health Service, which we wish to retain as it is.
The Minister says that practices have applied for budgetary status and that hospitals have applied for opting-out, but I challenge him to say whether any of them is in the Borders. I am pretty certain that they are not. Silence speaks more loudly on this occasion.

Mr. Bill Walker: rose——

Sir David Steel: The hon. Gentleman may have flown over my constituency in Concorde, but I trust that he will allow me not to give way for the moment. I have only just started and I want to spell out some of the anxieties of people in the Borders, since the Minister doubts me. He will have a chance to reply to the debate.
First, all hon. Members who represent Scottish constituencies know that there is no question but that there has always been a different ethos in the National Health Service in Scotland from that south of the border. General practitioners in my area find that as people come from the south, either for employment or to retire, they ask to go on to a private practice list. The GPs look at them and say, "What on earth are you talking about? We don't do private practice". They say that generally in that part of Scotland everyone is treated the same. Those people may have come from a part of England where it is different, but we do not do that in Scotland. Gradually people realise that they can get decent health care without getting

involved with private medicine. The medical profession expects that to continue in Scotland. The Bill is driving a coach and horses through that principle.
GPs point out that the Government have allowed a 5 per cent. increase in the cost of supplies and services in the current year, but that inflation in those areas is about 8 per cent. Therefore, there is a cut in the health board budget. The board has not been fully compensated for the funding of pay awards and for the regrading exercise, which has been a long, tedious and time-consuming exercise.
The result is that for the coming year the local area health board is £500,000 short of its budget. It has had to look around for savings to meet that shortfall. The first thing that it is proposing to do—it will cause an almighty row—is to renege on the undertakings which it gave about reopening the cottage hospitals at Selkirk and at Galashiels. That will cause a public outcry. It is no good the Minister saying that there are no cuts in the Health Service, because people can see with their own eyes that there is a difference between the service that the public expects and what it will get because of the shortfall in funding.
When the chief executive met much the same group that I met—or at any rate some of the consultants—he was asked about the future of the gastroenterology service in the Borders. Could he guarantee that it would continue? He said that the service could go if it proved non-competitive. What does that mean? As far as we can make out, it means that if a particular specialty, at present provided as part of a comprehensive Health Service in the Borders region, does not pay its way in accounting terms because there are not enough patients, that specialty might be closed and the patients transferred to Edinburgh. From an accountants' point of view, sitting in St. Andrew's house, that might make sense.
That brings me back to the whole question of the quality of the Health Service. What about patients who have to make a journey of 50 or 60 miles to hospital to be treated? What about their relatives? What about the quality of the service that they have come to expect? It cannot be an accounting exercise; it cannot be thought of just in terms of pounds, shillings and pence, as the Government propose.
Last year the orthopaedic service in the Borders general hospital was estimated to cost £30,000. The outturn was £69,000—more than double. These were mainly hip and knee joint operations. The increase in the demand for such operations has been colossal throughout the last decade or so. Ten years ago hip operations were rare; it was pioneering work. The elderly now expect such an operation to be provided. It is regarded as a facility. As the outturn was £69,000, the health board, due to its straitened budget, said to the hospital, "Next year you must budget for £48,000." If that is not a cut, what is?
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In the Government's plans for the Health Service great stress is laid—probably inevitably; I do not quarrel about it—on computerisation. The vaccination programme in the Borders has been computerised. However, general practitioners have been told that the programme must be stopped for nine months because the cost of the vaccine cannot be afforded. What sense does it make to set up a sophisticated programme and then to say that it cannot be used because the vaccine cannot be afforded?
A consultant told me that she had paid out of her own pocket the £100 that was necessary to buy a nebuliser for an elderly patient who could thus be allowed to go home, thereby releasing a badly needed hospital bed in an elderly patient unit. No money was available for that small item of equipment.
These are not fictitious pieces of propaganda, dreamt up by a central organisation; they are complaints by people who are operating the service in the way that the public expect it to be operated. No general practitioner in the Borders wants to move to a system under which he has to limit his practice budget. At the end of a long meeting last Sunday it was said that that was not what any of them had gone into medicine for.
If the Government were to ask people whether they would he prepared to pay more for the Health Service, the answer would be yes. The Government believe that, because expenditure on the National Health Service has inevitably increased, and will inevitably increase, no matter which party is in power, it must be cut, and that more and more of that expenditure should be borne by the private sector. The Government are changing the National Health Service into a national health business. That is not what is wanted.
If we cannot impede the Bill's progress, at least we should insist that some sort of external quality control commission should be added to the new system so that it can assess what facilities the National Health Service is failing to provide. That is what people want to know. The Government ought to remember that this is a service, not a private enterprise profit-making organisation. If they did, they would get back on the right tracks.

Mr. Harry Ewing: I detect some unrest among hon. Members. It is not something for which I apologise. The fact that the debate has continued into the early hours of the morning reflects the concern of Scottish Members of Parliament—particularly on this side of the House—about the direction in which the National Health Service is moving and has moved in Scotland, particularly since the hon. Member for Stirling (Mr. Forsyth) became Minister with responsibility for health in the Scottish Office.
Over the past two or three years, one of the saddest features of the Health Service in Scotland has been the way in which, by and large, we have moved from a consensus approach to confrontation. The one thing that is absolutely certain is that this is doing the Health Service, those who work in it and in particular those who use it, no good at all.
The right hon. Member for Tweeddale, Ettrick and Lauderdale (Sir D. Steel) referred to the Borders district general hospital. I was accompanied by the right hon. Gentleman when, as Health Minister, I went to purchase the cricket ground on which that hospital now stands. We had tremendous problems not only with the purchase of the land but with a certain Professor Trevor-Roper, about whom I still have nightmares.

Sir David Steel: He is now a Lord.

Mr. Ewing: Yes, he is now in another place. I remember well all the restrictions that he placed on the building of the Borders district general hospital.
I mention that only as a means of getting back to a point made by the hon. Member for Tayside, North (Mr. Walker)—the hospital building programme. It is the only point on which I shall take the hon. Gentleman up. It is the

very nature of politics that progammes started under one Government are continued and completed by a succeeding Government. [Laughter.] The hon. Member for Tayside, North is laughing. I hope that he will contain himself for a moment.
During the period of office of the 1974–79 Labour Government Monklands district general hospital and Inverclyde royal hospital were opened. North Ayrshire district general hospital could have been opened, but because of a serious defect in the ventilation system of the operating theatres we refused to accept it from the contractors. The biochemistry unit at Glasgow royal infirmary was opened during that period, and the foundations for the major reconstruction at Stirling royal infirmary were laid. The massive expansion at Raigmore hospital at Inverness was begun during the period of the 1974–79 Labour Government. A host of projects that had been started by the hon. Member for Dumfries (Sir H. Monro) were picked up first by my hon. Friend the Member for Aberdeen, North (Mr. Hughes), then by the late Frank McElhone, and then by me. Likewise, projects that had been started by me were picked up by Sir Russell Fairgrieve. The projects that were announced by the hon. Member for Stirling last week will not be opened officially by him; the official opening will be carried out by my hon. Friend the Member for Strathkelvin and Bearsden (Mr. Galbraith). That is in the nature of hospital building.

Mr. Bill Walker: I hope that the hon. Gentleman did not get the impression that I was suggesting that there had been no programmes during the period of the Labour Government. That would have been nonsense. I was making the point that the Labour Government, at the behest of the IMF, had to make savage cuts in their capital spending programme. If the hon. Gentleman is saying that that did not happen, he is contradicting the record.

Mr. Ewing: The hon. Gentleman was not in the House at that time. Let me tell him that at no time—even when the Labour Government went to the IMF—was any Scottish hospital or health centre that was under construction restricted or delayed. If the hon. Gentleman examines the record he will find that my comments are absolutely accurate. The Minister mentions Health Service expenditure from time to time. Sometimes politicians distort the record—I suppose that I am as good at it as anyone else—but if Government Ministers check the record they will find that throughout very difficult times during the period of the Labour Government there was constant growth of 1 per cent. in real terms. All this talk about Health Service spending being cut is rubbish.
But that is not what the new clause is about. I can sense that you are becoming a bit concerned, Madam Deputy Speaker. I am astonished that the Minister seems to be poised to resist the new clause. I wish that this measure were not necessary. The hon. Member for Dumfries has been here throughout the debate, so I do not complain because he is not here at the moment. If he were in the Chamber, he would confirm what happened when he reorganised the Health Service. Three wings—the hospital board wing; the preventive medicine side, which was run not by the Health Service but by the education authorities; and the family practitioner wing—were brought together into a co-ordinated Health Service. That was done by


agreement on the Floor of the House, with little whipping on the legislation. The treatment of health care in Scotland occurred through the ages.
The Minister announced last week the setting up of a body above the health boards in order, he said, to impose the Government's policy on them. If that is the purpose of that body, it must be counterbalanced. That would be done by the very body which the new clause would set up. There must be a counterbalance for patients. If one body acts on the Minister's behalf and imposes Government policies where sometimes they would be resisted by health boards, there must be a consumer voice. It would be in the quality control commission that is suggested in the new clause, as amended by the amendment tabled by the hon. Member for Moray (Mrs. Ewing).
I have listened with great interest to hon. Members who have waxed eloquent about the standard of health care in their constituencies. I cannot do the same, but that is not a criticism of the doctors, consultants, nurses or anybody else who works in Falkirk royal infirmary. The problem is the net result of the constant transfer of facilities and services from Falkirk royal infirmary to sustain Stirling royal infirmary in the Minister's constituency. [Laughter.] The Minister laughs, but let us see how he laughs off my next remarks.
The ear, nose and throat department was transferred from Falkirk royal infirmary to sustain Stirling royal infirmary. My constituents have to travel many miles from their villages to see their children who are having their tonsils removed or to see their old folk when they are having eye operations. That must be measured in terms of quality control. The quality of health care that my constituents have to put up with must be measured against the inconvenience and trouble to which they have been put because the department has been moved 15 miles along the road to Stirling royal infirmary.
Hospitals are accredited for training purposes by the royal colleges. Stirling royal infirmary is not recognised as a training hospital for consultant anaesthetists because it does not carry out the range of anaesthetic work necessary for people to qualify. The Forth Valley health board is trying to correct the problem, not by getting more patients into Stirling royal infirmary—which could be done—but by transferring work from Falkirk royal infirmary to provide the necessary range at Stirling royal infirmary. Before we know what is going on, facilities will be transferred to Falkirk and our hospital will be downgraded.
My hon. Friend the Member for Falkirk, West (Mr. Canavan) has to tolerate such problems. They should be measured by a quality control commission. Such a commission would be able to prove that we could get more patients into Stirling royal infirmary. I have an interest in that hospital, too, and I have a high regard for it. I had close contacts with it during my 13 years as a Member of Parliament representing a constituency that includes Stirling.
1.45 am
The hon. Member for Dumfries referred to a survey that the Minister commissioned about a year ago, yet the Minister has referred to that survey only once. It covered a host of experience of patients in our hospitals. It covered what they thought of meals, of visiting hours and of the

facilities available. One aspect of that survey—the number of patients being referred to hospitals outside their health board area—was very interesting. In each of the health board areas in Scotland, the average was 3 per cent. to 5 per cent. That can be accounted for easily by the need to refer to the specialist centres. No one would argue that we should have such specialist centres in every health board area, but in the Forth Valley health board area the figure was 17 per cent.
The Minister knows better than I do that general practitioners in the landward area, which is the western part of the Forth Valley health board's area—in the Minister's constituency—are referring patients to Edinburgh and Glasgow for general examinations which should be carried out at Stirling royal infirmary. Any treatment arising from those general examinations should also be performed at Stirling royal infirmary. We are talking about measuring quality of service to patients, and about the quality of health care that should be provided to the community. We must take into account whether such health care is there at all. For many years in Falkirk, we have enjoyed such health care provided expertly by good people at Falkirk and District royal infirmary.
I tell the Minister, in the kindest possible way, that we are in no mood to give up that care lightly. The Forth Valley health board's option appraisal is still to be published and the Minister has, in many ways, pre-empted that option appraisal by references to facilities at Stirling royal infirmary, which we shall not debate tonight, but will keep for another time. However, if there is any suggestion that Falkirk and District royal infirmary should be downgraded and that more services should be transferred, thus reducing the service to our people, the Minister will have a fight on his hands.
I found the speech of my hon. Friend the Member for Glasgow, Rutherglen (Mr. McAvoy) very disturbing. I cannot for the life of me think how a self-respecting Minister of any political party could go within 10 miles of a deal such as the one my hon. Friend explained to the House tonight. Even without this debate and even without the new clause on which to base it, my hon. Friend's speech could have stood on its own. He raised a very serious issue. The hon. Member for Tayside, North talks about the Public Accounts Committee examining the matter far better than it would have been examined by the Select Committee on Scottish Affairs. The issue that my hon. Friend the Member for Rutherglen raised is so serious—I do not say this lightly and I am not given to calling for public inquiries—as to require the closest public examination.
Quality control is about the availability of a service. If a service is not available or if it is taken away, we would examine that closely. That is why I shall support my hon. Friends in the Lobby tonight.

Mr. Michael Forsyth: We have had a long debate and it may be for the convenience of the House if I intervene now.
The hon. Member for Glasgow, Cathcart (Mr. Maxton) some hours ago made a number of points when moving the new clause. I echo the remarks of the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood). I too was puzzled by the organisations that the hon. Member for Cathcart suggested should be consulted about the membership of the proposed body. He did not mention the Royal College of Nursing, the British Medical


Association and other professional bodies. That was surprising, given his concern about the Health Service. It was revealing about his real intentions.
I will not respond to all the points that the hon. Member for Cathcart made about competitive tendering, which he insisted on calling privatisation, despite the fact that he acknowledged that three quarters of the contracts had been awarded in-house. I noted his comments about standards. If he was critical of standards, they cannot have been the standards of specification in the contracts. He must have been referring to the execution of the contracts, and I took that to be an attack on the performance of the in-house teams.
The hon. Gentleman said that fines were being levied in respect of some contracts. Given that the whole process of competitive tendering is about defining the level of service required, ensuring that that service is subsequently delivered and implementing the procedures for fining private contractors where they fall below standard, I should have thought that that met the requirements that the hon. Gentleman was putting forward in the new clause for the proper policing of standards in the NHS.
It is not possible to impose fines and take sanctions where contracts are held in-house, which is in by far the majority of cases, but in the light of the hon. Gentleman's remarks I will look again at the procedures that are in place for policing the standards of performance of in-house contracts and the activities of the boards in seeing that that which was promised when the contract was awarded is delivered.
I found it remarkable that in the history that the hon. Member for Cathcart gave of the process by which competitive tendering was embarked on in Scotland at no point did he say that nearly £60 million had been released as additional resources for health boards.

Mr. Brian Wilson: Nobody believes it.

Mr. Forsyth: I answered a parliamentary question—it is available in the Library—which set out all the additional services that the boards had bought with the savings resulting from that process. Simply saying "Nobody believes it" is not a way of substituting for the facts.
My hon. Friend the Member for Dumfries (Sir H. Monro), in an excellent contribution—one of the few which addressed the issue in the new clause—highlighted the fact that the new clause would result in substantial additional costs for the NHS, money that would be diverted from patient care. It could be financed only at the expense of less progress being made on reducing waiting lists and not extending the range and quality of treatment available to patients.
As my hon. Friend pointed out, the whole point of the White Paper proposals and the Bill is to try to bring about a separation between the role of health boards as purchasers and as providers. The role of ensuring the highest standards of quality and policing the quality of service is that of the health boards. The idea that we should set up a new organisation to take over the role of health boards is extraordinary, a point that was also made by my hon. Friend the Member for Tayside, North (Mr. Walker).
As my hon. Friend the Member for Dumfries said, the NHS today in Scotland is better than it was a year ago, and I agree with him that in a year from now it will be better still, particularly as a result of this measure becoming law.
The hon. Member for Roxburgh and Berwickshire, in an intriguing split with his right hon. Friend the Member for Tweeddale, Ettrick and Lauderdale (Sir D. Steel), informed us that his constituency in the Borders had an excellent health board and nothing to complain about. In fact, he interrupted to say, "If it ain't broke, don't fix it." Apologies for the grammar, but I agree with the hon. Gentleman. He is right: the Borders has a brand-new hospital and an excellent Health Service. Nevertheless, his right hon. Friend subsequently listed a series of complaints.
My hon. Friend the Member for Dumfries rightly spoke of the importance of dialysis being available within easy travelling distance of patients, while at the same time acknowledging the difficulties of providing such facilities in rural areas. I am happy to assure my hon. Friend that we are keen for progress to be made in that regard. Unlike Opposition Members, we feel that, if it is possible to provide them more cheaply by involving the private sector, it should be done: we have no ideological baggage to prevent us from acting in the interests of patients. The hon. Member for Glasgow, Rutherglen (Mr. McAvoy) smiles. [Interruption.] I will deal with his allegations in a moment, but let me ask him for the third time whether he is asking me to prevent Takare from providing that facility in his constituency.

Mr. McAvoy: Let me repeat for the third time what I said. I, as Member of Parliament, and the whole community of Cambuslang and Rutherglen do not want the deal, because of the lack of principle and because of the financial details. Will the Minister confirm, for the first time tonight, what I have said about the financial details of the proposed deal with Takare or will he take this opportunity to tell us the details, in the interests of truth?

Mr. Forsyth: What I will say is that the Greater Glasgow health board's proposals were examined in detail by my officials, who believe that they represent value for money. They required the approval of the Treasury, which—after examining them in detail—is also satisfied that they represent value for money. The hon. Gentleman has made a series of allegations which I shall certainly pursue, but I take if from what he has said that he does not wish to see the Takare facility in his constituency.
The hon Member for Moray (Mrs. Ewing) made a number of points, but she was particularly worried about a reduction in the number of local health councils. The Bill provides for the provision of more than one health council where it is considered necessary, and when the Grampian health board's proposals are presented we shall bear her views in mind.
The hon. Member for Aberdeen, North (Mr. Hughes), who made the same point about health councils, very fairly explained the divergence of view between him and the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith). He mentioned the work of the Mental Welfare Commission. May I add that we also have the Scottish Hospital Advisory Service, the Health Service Commissioner and a number of other agencies, all of which would provide for the functions proposed in the new clause.
The right hon. Member for Tweeddale, Ettrick and Lauderdale spoke of the difficulties with his orthopaedic service. I am not familiar with the budget, but it may have


been inflated by the waiting list initiative which has resulted in a considerable reduction. In the Borders, with a new hospital, the waiting list is more or less at base level.
The right hon. Gentleman's example of the nebuliser is precisely the kind of thing that the reforms are designed to change. He explained the frustration of doctors who found that for the sake of £100 they could not get a patient out of hospital. That is ridiculous. The principles of money following the patient and the devolution of management responsibility at hospital level are designed to cut precisely the kind of red tape about which the right hon. Gentleman was complaining.
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The hon. Member for Falkirk, East (Mr. Ewing) said that one Government may commission a hospital but the credit for it will be taken by the Government in power when it is built. This Government have presided over the biggest capital investment programme in the history of the Health Service. The Labour Government cut the hospital building programme. In reply to my hon. Friend the Member for Tayside, North, the hon. Gentleman said that no project that was being built was delayed. What he did not mention was all the projects which were not started and which were delayed because of the Labour Government's incompetence.

Mr. Harry Ewing: Has the Minister got a list of those projects?

Mr. Forsyth: If the hon. Gentleman puts down a parliamentary question, I shall happily reply to it.

Mr. Ewing: Will the Minister give way?

Mr. Forsyth: I have covered the point. If the hon. Gentleman is sure of his position, he should put down a parliamentary question and I shall answer it.

Mr. Ewing: On a point of order, Madam Deputy Speaker. The Minister said that there was a list of projects that were stopped or were not started. I asked the Minister for the list and you clearly heard him say that he did not have one. Is that misleading the House or is it not?

Madam Deputy Speaker (Miss Betty Boothroyd): The Chair hears a number of things during debates, but there has been no breach of our Standing Orders.

Mr. Forsyth: If the hon. Gentleman has found a way of cutting the hospital building programme and maintaining its progress, I would be interested to hear about it because it would be useful not only for me but for other Ministers with responsibility for health.

Mr. Maxton: I thought that the Minister was about to finish. Opposition Members would be interested to have the names of the four hospitals in Scotland that have expressed an interest in opting out.

Mr. Forsyth: I am sure that the hon. Gentleman would like to have the names of those four hospitals and no doubt in due course those names will be available to him.

Mr. Maxton: When?

Mr. Forsyth: In due course, when those who have expressed an interest are content to do so.

Mr. George Foulkes: Will the Minister give way on that point?

Mr. Forsyth: Finally——

Mr. Foulkes: rose——

Madam Deputy Speaker: Order. The Minister is not giving way.

Mr. Forsyth: The hon. Member for Falkirk, East made a serious point about the facilities at Falkirk and Stirling. I assure him that it is central to the aims of our White Paper and to the Bill that health boards should fulfil their function to ensure that services are available to communities which reflect their needs. That is what they have to make a judgment on. I agree that basic essential services should be available to patients within reasonable travelling distance. I am well aware of the distances that people have to travel to Stirling royal infirmary and to Falkirk. Therefore, the hon. Gentleman would do well to see what emerges from the health board before jumping to conclusions.
For those reasons, I suggest that the hon. Member for Cathcart should withdraw his new clause.

Mr. Kirkwood: I certainly have no intention of detaining the House for any longer than I can help. However, the Minister's speech deserves some response.
If the thrust of the new clause is, as I understand it, to try to establish some new standards of quality control in the Health Service, it must be of some interest to the House to know exactly what the response has been to the Bill's proposals from general practitioners who have expressed an interest in the GP budget-holding facility. More importantly, and more immediately, it is important to know a bit more about the details of the hospitals which have expressed an interest—that is all that they can do at present—in the Bill's provisions.
If there were sensible guarantees about the quality of the service that could be provided under the Bill's terms, more hospitals in particular, as well as general practitioners, would be expressing an interest in the proposals for opting out or moving towards self-governing status. It is important for the rest of the debate to know a bit more about the types of hospital which have been expressing an interest in the Bill's provisions so that we can judge whether the new clause is necessary.
The competitive and free-market thrust of the Bill, certainly where it relates to rural areas, requires a cast-iron guarantee of quality assurance if the Bill is to be put on the statute book. If the Minister is not prepared to accept the new clause, he and the Government should be prepared to accept new clause 16. The suggestions it contains have come from the Royal College of Nursing, which set out alternative proposals for advisory boards. In principle, they would achieve the same end as new clause 2 and reflect the interests of health professionals a bit better than that new clause 2 and, in principle, I support them.
The Government are determined to proceed with this new internal market procedure and moving towards more commercial interests being introduced into the National Health Service. I listened carefully to the speech of the hon. Member for Dumfries (Sir H. Monro) and he certainly did not convince me that the health care provision in Dumfries and the Borders requires a new competitive system. If the Health Service in the Borders area is divided into a system of providers, with National


Health Service trusts and opted-out hospitals on one side and health board acquirals, the basis of contracts and the edifice of bureaucracy which that would spawn would not he worth a candle. The improvements, if any, that would be effected would not be worth having. That is true of competitive tendering. The costs involved for a board the size of the Borders health board for doing the specifications for the contracts do not measure up to the savings that can be made.
Therefore, the Minister is unjustified in saying that there is a difference of opinion between my right hon. Friend the Member for Tweeddale, Ettrick and Lauderdale (Sir D. Steel) and me. We both say that the system in place for administering health care in the Borders is perfectly adequate and needs just a little extra money, not a vast amount, to make the present system work that much more smoothly. If the Minister insists on inflicting this new edifice of a free market on rural areas, he risks losing good will, prejudicing staff morale and losing the integration and co-operation between health professionals—and all for the ideological purpose of installing and instituting a free market system.
A system of quality control will be necessary in rural areas if the Bill is passed. For the reasons mentioned by the hon. Member for Dumfries, the only way to avoid the need for the new clause would be to remove the provision in the Bill. The Minister would have the co-operation and agreement of the health professionals in the Borders if he stepped back from full implementation of the Bill and instead introduced a system of pilot studies, on a selective basis over a period, so that we could assess the results. The new clause would not then be necessary. However, if the Minister insists on sticking to the whole system proposed in the Bill, it is essential, especially in rural areas, that there be some system to guarantee quality control.
If the Minister is not prepared to accept the new clause, he should say, first, which hospitals have directly expressed interest in self-governing status, and, secondly, whether he will accept new clause 15 or new clause 16.

The Parliamentary Secretary to the Treasury (Mr.Timothy Renton): rose in his place and claimed to move, That the Question be now put:-

Question put, That the Question be now put.

The House divided. Ayes 219, Noes 87.

Division No. 115]
[2.11 am


AYES


Alexander, Richard
Bowis, John


Alison, Rt Hon Michael
Brazier, Julian


Allason, Rupert
Bright, Graham


Amess, David
Brooke, Rt Hon Peter


Amos, Alan
Brown, Michael (Brigg &amp; Cl't's)


Arbuthnot, James
Bruce, Ian (Dorset South)


Arnold, Jacques (Gravesham)
Budgen, Nicholas


Arnold, Tom (Hazel Grove)
Burns, Simon


Baker, Nicholas (Dorset N)
Butcher, John


Baldry, Tony
Butler, Chris


Batiste, Spencer
Butterfill, John


Bellingham, Henry
Carlisle, Kenneth (Lincoln)


Bendall, Vivian
Carrington, Matthew


Bennett, Nicholas (Pembroke)
Carttiss, Michael


Blaker, Rt Hon Sir Peter
Cash, William


Bonsor, Sir Nicholas
Chalker, Rt Hon Mrs Lynda


Boscawen, Hon Robert
Channon, Rt Hon Paul


Boswell, Tim
Chapman, Sydney


Bottomley, Peter
Clarke, Rt Hon K. (Rushcliffe)


Bottomley, Mrs Virginia
Colvin, Michael


Bowden, A (Brighton K'pto'n)
Conway, Derek


Bowden, Gerald (Dulwich)
Coombs, Anthony (Wyre F'rest)





Coombs, Simon (Swindon)
Lord, Michael


Cope, Rt Hon John
Luce, Rt Hon Richard


Couchman, James
MacKay, Andrew (E Berkshire)


Cran, James
Maclean, David


Currie, Mrs Edwina
McLoughlin, Patrick


Curry, David
Malins, Humfrey


Davies, Q. (Stamf'd &amp; Spald'g)
Mans, Keith


Davis, David (Boothferry)
Maples, John


Day, Stephen
Marland, Paul


Devlin, Tim
Marshall, Michael (Arundel)


Dorrell, Stephen
Martin, David (Portsmouth S)


Douglas-Hamilton, Lord James
Maude, Hon Francis


Dover, Den
Mayhew, Rt Hon Sir Patrick


Dunn, Bob
Mellor, David


Emery, Sir Peter
Meyer, Sir Anthony


Evans, David (Welwyn Hatf'd)
Mills, Iain


Evennett, David
Mitchell, Andrew (Gedling)


Fallon, Michael
Mitchell, Sir David


Fenner, Dame Peggy
Moate, Roger


Fishburn, John Dudley
Monro, Sir Hector


Forman, Nigel
Moss, Malcolm


Forsyth, Michael (Stirling)
Neale, Gerrard


Forth, Eric
Nelson, Anthony


Franks, Cecil
Neubert, Michael


Freeman, Roger
Nicholls, Patrick


French, Douglas
Nicholson, David (Taunton)


Gale, Roger
Nicholson, Emma (Devon West)


Gardiner, George
Onslow, Rt Hon Cranley


Garel-Jones, Tristan
Oppenheim, Phillip


Gill, Christopher
Paice, James


Glyn, Dr Sir Alan
Patnick, Irvine


Goodhart, Sir Philip
Patten, Rt Hon Chris (Bath)


Goodlad, Alastair
Patten, Rt Hon John


Goodson-Wickes, Dr Charles
Pawsey, James


Gorst, John
Peacock, Mrs Elizabeth


Gow, Ian
Porter, David (Waveney)


Greenway, John (Ryedale)
Price, Sir David


Gregory, Conal
Raison, Rt Hon Timothy


Grist, Ian
Rathbone, Tim


Ground, Patrick
Redwood, John


Hague, William
Renton, Rt Hon Tim


Hamilton, Neil (Tatton)
Roe, Mrs Marion


Hampson, Dr Keith
Rossi, Sir Hugh


Hanley, Jeremy
Rowe, Andrew


Hannam, John
Rumbold, Mrs Angela


Hargreaves, A. (B'ham H'll Gr')
Ryder, Richard


Harris, David
Sackville, Hon Tom


Haselhurst, Alan
Sayeed, Jonathan


Hawkins, Christopher
Shaw, Sir Giles (Pudsey)


Hayes, Jerry
Shaw, Sir Michael (Scarb')


Hayward, Robert
Shephard, Mrs G. (Norfolk SW)


Heathcoat-Amory, David
Shepherd, Colin (Hereford)


Hicks, Mrs Maureen (Wolv' NE)
Shersby, Michael


Hicks, Robert (Cornwall SE)
Sims, Roger


Higgins, Rt Hon Terence L.
Smith, Sir Dudley (Warwick)


Hind, Kenneth
Smith, Tim (Beaconsfield)


Holt, Richard
Speller, Tony


Howarth, Alan (Strat'd-on-A)
Spicer, Sir Jim (Dorset W)


Hughes, Robert G. (Harrow W)
Squire, Robin


Hunt, Sir John (Ravensbourne)
Stanbrook, Ivor


Irvine, Michael
Stanley, Rt Hon Sir John


Jack, Michael
Stevens, Lewis


Jackson, Robert
Stewart, Andy (Sherwood)


Janman, Tim
Stradling Thomas, Sir John


Jessel, Toby
Summerson, Hugo


Johnson Smith, Sir Geoffrey
Tapsell, Sir Peter


Jones, Gwilym (Cardiff N)
Taylor, Ian (Esher)


Jones, Robert B (Herts W)
Taylor, John M (Solihull)


Key, Robert
Taylor, Teddy (S'end E)


King, Roger (B'ham N'thfield)
Thompson, D. (Calder Valley)


Kirkhope, Timothy
Thompson, Patrick (Norwich N)


Knapman, Roger
Thorne, Neil


Knight, Greg (Derby North)
Thornton, Malcolm


Knight, Dame Jill (Edgbaston)
Thurnham, Peter


Lang, Ian
Townsend, Cyril D. (B'heath)


Lawrence, Ivan
Tredinnick, David


Lee, John (Pendle)
Trippier, David


Leigh, Edward (Gainsbor'gh)
Trotter, Neville


Lennox-Boyd, Hon Mark
Twinn, Dr Ian


Lloyd, Peter (Fareham)
Walker, Bill (T'side North)






Waller, Gary
Wolfson, Mark


Ward, John
Wood, Timothy


Wardle, Charles (Bexhill)
Yeo, Tim


Watts, John
Young, Sir George (Acton)


Wells, Bowen
Younger, Rt Hon George


Wheeler, Sir John



Widdecombe, Ann
Tellers for the Ayes:


Wilshire, David
Mr. Tony Durant and Mr. David Lightbown.


Winterton, Mrs Ann



Winterton, Nicholas





NOES


Abbott, Ms Diane
Kennedy, Charles


Alton, David
Kilfedder, James


Barnes, Harry (Derbyshire NE)
Kirkwood, Archy


Battle, John
Livsey, Richard


Bennett, A. F. (D'nt'n &amp; R'dish)
Lloyd, Tony (Strettord)


Bradley, Keith
McAvoy, Thomas


Bruce, Malcolm (Gordon)
McCartney, Ian


Buckley, George J.
McKay, Allen (Barnsley West)


Campbell-Savours, D. N.
McKelvey, William


Carlile, Alex (Mont'g)
McLeish, Henry


Clarke, Tom (Monklands W)
Madden, Max


Clelland, David
Mahon, Mrs Alice


Cook, Robin (Livingston)
Martin, Michael J. (Springburn)


Cousins, Jim
Maxton, John


Cryer, Bob
Meale, Alan


Dalyell, Tam
Michael, Alun


Davies, Ron (Caerphilly)
Michie, Bill (Sheffield Heeley)


Davis, Terry (B'ham Hodge H'l)
Michie, Mrs Ray (Arg'l &amp; Bute)


Dewar, Donald
Morgan, Rhodri


Dixon, Don
Murphy, Paul


Eadie, Alexander
Nellist, Dave


Evans, John (St Helens N)
Patchett, Terry


Ewing, Harry (Falkirk E)
Pike, Peter L


Ewing, Mrs Margaret (Moray)
Powell, Ray (Ogmore)


Flynn, Paul
Primarolo, Dawn


Foster, Derek
Redmond, Martin


Foulkes, George
Ross, Ernie (Dundee W)


Fyfe, Maria
Rowlands, Ted


Godman, Dr Norman A.
Spearing, Nigel


Graham, Thomas
Steel, Rt Hon Sir David


Griffiths, Win (Bridgend)
Turner, Dennis


Hardy, Peter
Wallace, James


Harman, Ms Harriet
Wareing, Robert N.


Haynes, Frank
Watson, Mike (Glasgow, C)


Hinchliffe, David
Welsh, Andrew (Angus E)


Home Robertson, John
Welsh, Michael (Doncaster N)


Hood, Jimmy
Williams, Rt Hon Alan


Howarth, George (Knowsley N)
Wilson, Brian


Howells, Dr. Kim (Pontypridd)
Winnick, David


Hoyle, Doug
Wise, Mrs Audrey


Hughes, Robert (Aberdeen N)



Hughes, Simon (Southwark)
Tellers for the Noes:


Ingram, Adam
Mrs. Llin Golding and Mr. Jimmy Dunnachie.


Jones, Barry (Alyn &amp; Deeside)



Jones, Ieuan (Ynys Môn)

Question accordingly agreed to

Question put accordingly, That the clause be read a Second time:—

The House deveded: Ayes 87, Noes 215.

Division No. 116]
[2.23 am


AYES


Abbott, Ms Diane
Dalyell, Tam


Alton, David
Davies, Ron (Caerphilly)


Barnes, Harry (Derbyshire NE)
Davis, Terry (B'ham Hodge H'l)


Battle, John
Dewar, Donald


Bennett, A. F. (D'nt'n &amp; R'dish)
Dixon, Don


Bradley, Keith
Eadie, Alexander


Bruce, Malcolm (Gordon)
Evans, John (St Helens N)


Buckley, George J.
Ewing, Harry (Falkirk E)


Campbell-Savours, D. N.
Ewing, Mrs Margaret (Moray)


Carlile, Alex (Mont'g)
Flynn, Paul


Clarke, Tom (Monklands W)
Foster, Derek


Clelland, David
Foulkes, George


Cook, Robin (Livingston)
Fyfe, Maria


Cousins, Jim
Godman, Dr Norman A.


Cryer, Bob
Golding, Mrs Llin





Graham, Thomas
Michie, Bill (Sheffield Heeley)


Griffiths, Win (Bridgend)
Michie, Mrs Ray (Arg'l &amp; Bute)


Hardy, Peter
Morgan, Rhodri


Harman, Ms Harriet
Murphy, Paul


Hinchliffe, David
Nellist, Dave


Home Robertson, John
Patchett, Terry


Hood, Jimmy
Pike, Peter L.


Howarth, George (Knowsley N)
Powell, Ray (Ogmore)


Howells, Dr. Kim (Pontypridd)
Primarolo, Dawn


Hoyle, Doug
Redmond, Martin


Hughes, Robert (Aberdeen N)
Ross, Ernie (Dundee W)


Hughes, Simon (Southwark)
Rowlands, Ted


Ingram, Adam
Short, Clare


Jones, Barry (Alyn &amp; Deeside)
Skinner, Dennis


Jones, leuan (Ynys Môn)
Spearing, Nigel


Kennedy, Charles
Steel, Rt Hon Sir David


Kilfedder, James
Turner, Dennis


Kirkwood, Archy
Wallace, James


Livsey, Richard
Wareing, Robert N.


Lloyd, Tony (Stretford)
Watson, Mike (Glasgow, C)


McAvoy, Thomas
Welsh, Andrew (Angus E)


McCartney, Ian
Welsh, Michael (Doncaster N)


McKay, Allen (Barnsley West)
Williams, Rt Hon Alan


McKelvey, William
Wilson, Brian


McLeish, Henry
Winnick, David


Madden, Max
Wise, Mrs Audrey


Mahon, Mrs Alice



Martin, Michael J. (Springburn)
Tellers for the Ayes:


Maxton, John
Mr. Frank Haynes and Mr. Jimmy Dunnachie.


Meale, Alan



Michael, Alun





NOES


Alexander, Richard
Currie, Mrs Edwina


Alison, Rt Hon Michael
Davies, Q. (Stamf'd &amp; Spald'g)


Allason, Rupert
Davis, David (Boothferry)


Amess, David
Day, Stephen


Amos, Alan
Devlin, Tim


Arbuthnot, James
Dorrell, Stephen


Arnold, Jacques (Gravesham)
Douglas-Hamilton, Lord James


Arnold, Tom (Hazel Grove)
Dover, Den


Baldry, Tony
Dunn, Bob


Batiste, Spencer
Emery, Sir Peter


Bellingham, Henry
Evans, David (Welwyn Hatf'd)


Bendall, Vivian
Evennett, David


Bennett, Nicholas(Pembroke)
Fallon, Michael


Blaker, Rt Hon Sir Peter
Fenner, Dame Peggy


Bonsor, Sir Nicholas
Fishburn, John Dudley


Boscawen, Hon Robert
Forman, Nigel


Boswell, Tim
Forsyth, Michael (Stirling)


Bottomley, Peter
Forth, Eric


Bottomley, Mrs Virginia
Franks, Cecil


Bowden, A (Brighton K'pto'n)
Freeman, Roger


Bowden, Gerald (Dulwich)
French, Douglas


Bowis, John
Gale, Roger


Brazier, Julian
Gardiner, George


Bright, Graham
Garel-Jones, Tristan


Brooke, Rt Hon Peter
Gill, Christopher


Brown, Michael (Brigg &amp; Cl't's)
Glyn, Dr Sir Alan


Bruce, Ian (Dorset South)
Goodhart, Sir Philip


Budgen, Nicholas
Goodlad, Alastair


Burns, Simon
Goodson-Wickes, Dr Charles


Butcher, John
Gorst, John


Butler, Chris
Gow, Ian


Butterfill, John
Greenway, John (Ryedale)


Carlisle, Kenneth (Lincoln)
Gregory, Conal


Carrington, Matthew
Grist, Ian


Carttiss, Michael
Ground, Patrick


Cash, William
Hague, William


Chalker, Rt Hon Mrs Lynda
Hamilton, Neil (Tatton)


Channon, Rt Hon Paul
Hampson, Dr Keith


Chapman, Sydney
Hanley, Jeremy


Clarke, Rt Hon K. (Rushcliffe)
Hannam, John


Colvin, Michael
Hargreaves, A. (B'ham H'll Gr')


Conway, Derek
Harris, David


Coombs, Anthony (Wyre F'rest)
Haselhurst, Alan


Coombs, Simon (Swindon)
Hawkins, Christopher


Cope, Rt Hon John
Hayes, Jerry


Couchman, James
Hayward, Robert


Cran, James
Heathcoat-Amory, David






Hicks, Mrs Maureen (Wolv' NE)
Price, Sir David


Hicks, Robert (Cornwall SE)
Raison, Rt Hon Timothy


Higgins, Rt Hon Terence L.
Rathbone, Tim


Hind, Kenneth
Redwood, John


Holt, Richard
Renton, Rt Hon Tim


Howarth, Alan (Strat'd-on-A)
Rossi, Sir Hugh


Hughes, Robert G. (Harrow W)
Rowe, Andrew


Hunt, Sir John (Ravensbourne)
Rumbold, Mrs Angela


Irvine, Michael
Ryder, Richard


Jack, Michael
Sackville, Hon Tom


Janman, Tim
Sayeed, Jonathan


Jessel, Toby
Shaw, Sir Giles (Pudsey)


Johnson Smith, Sir Geoffrey
Shaw, Sir Michael (Scarb')


Jones, Gwilym (Cardiff N)
Shephard, Mrs G. (Norfolk SW)


Jones, Robert B (Herts W)
Shepherd, Colin (Hereford)


Key, Robert
Shersby, Michael


King, Roger (B'ham N'thfield)
Sims, Roger


Kirkhope, Timothy
Smith, Sir Dudley (Warwick)


Knapman, Roger
Smith, Tim (Beaconsfield)


Knight, Greg (Derby North)
Speller, Tony


Knight, Dame Jill (Edgbaston)
Spicer, Sir Jim (Dorset W)


Lang, Ian
Squire, Robin


Lawrence, Ivan
Stanbrook, Ivor


Lee, John (Pendle)
Stanley, Rt Hon Sir John


Leigh, Edward (Gainsbor'gh)
Stevens, Lewis


Lennox-Boyd, Hon Mark
Stewart, Andy (Sherwood)


Lightbown, David
Stradling Thomas, Sir John


Lloyd, Peter (Fareham)
Summerson, Hugo


Lord, Michael
Tapsell, Sir Peter


Luce, Rt Hon Richard
Taylor, Ian (Esher)


Lyell, Rt Hon Sir Nicholas
Taylor, John M (Solihull)


MacKay, Andrew (E Berkshire)
Taylor, Teddy (S'end E)


Maclean, David
Thompson, D. (Calder Valley)


McLoughlin, Patrick
Thompson, Patrick (Norwich N)


Malins, Humfrey
Thorne, Neil


Mans, Keith
Thornton, Malcolm


Maples, John
Thurnham, Peter


Marland, Paul
Townsend, Cyril D. (B'heath)


Marshall, Michael (Arundel)
Tredinnick, David


Martin, David (Portsmouth S)
Trippier, David


Mayhew, Rt Hon Sir Patrick
Trotter, Neville


Mellor, David
Twinn, Dr Ian


Meyer, Sir Anthony
Walker, Bill (T'side North)


Mills, Iain
Waller, Gary


Mitchell, Andrew (Gedling)
Ward, John


Mitchell, Sir David
Wardle, Charles (Bexhill)


Moate, Roger
Watts, John


Monro, Sir Hector
Wells, Bowen


Moss, Malcolm
Wheeler, Sir John


Neale, Gerrard
Widdecombe, Ann


Nelson, Anthony
Wilshire, David


Neubert, Michael
Winterton, Mrs Ann


Nicholls, Patrick
Winterton, Nicholas


Nicholson, David (Taunton)
Wolfson, Mark


Nicholson, Emma (Devon West)
Wood, Timothy


Onslow, Rt Hon Cranley
Yeo, Tim


Oppenheim, Phillip
Young, Sir George (Acton)


Paice, James
Younger, Rt Hon George


Patnick, Irvine



Patten, Rt Hon John
Tellers for the Noes:


Pawsey, James
Mr, Tony Durant and Mr. Nicholas Baker.


Peacock, Mrs Elizabeth



Porter, David (Waveney)

Question accordingly negatived.

New Clause 3

CONSTITUTION OF COMMUNITY HEALTH COUNCILS IN WALES

'( ) (1) A Community Health Council shall be constituted for each District in Wales and

(a)shall assume in its area, such responsibilities and duties in relation to health matters and services as are undertaken by the existing Community Health Councils;
(b)shall be invited by the relevant county council to participate in the formulation of Community Care Plans as specified in section 43 of this Act;

(c)shall seek to co-ordinate the views of relevant voluntary and charitable groups, the recipients of community care and other health services and their carers, and to convey those views to the appropriate county and district councils, district health authorities, special health authorities and the Health Service Directorate of the Welsh Office as appropriate;
(d)shall monitor the delivery of health and community care services to people in its area, including the complementary provision of social, health and housing services;
(e)shall issue an annual report on its work;
(f)shall receive reports from any Independent Inspection Unit to be established by the Secretary of State as may report on services in its area;
(g)shall issue reports on specific topics from time to time as it sees fit;
(h)shall be authorised to hold joint meetings to consider such matters of common interest within the terms of paragraphs (a) to (e) above as are set out in the notice convening the meeting and may seek to reach a common view on such topics in accordance with Standing Orders agreed by the constituent Community Health Councils and approved by the Secretary of State.

(2)Community Care Services in this section shall be those defined in section 43 of this Act.

(3)Districts in this section shall be co-terminous with the areas served by District Councils in Wales.

(4)Community Health Councils established under this section shall be treated as successor bodies to the existing Community Health Councils under regulations to be established by the Secretary of State.'.—[Mr. Michael]

Brought up, and read the First time.

Mr. Alun Michael: I beg to move, That the clause be read a Second time.
The new clause aims to offer the individual, that is the patient, the consumer and the community in Wales, a real voice in the Health Service of the future. It aims to protect the interests of elderly, disabled and mentally ill people who are to be cared for in the community. It is logical to give the community health council a role in the two parts of the Bill which affect Wales. Health provision and care in the community must be complementary if the new system is to work.
The care in the community proposals need careful monitoring. Otherwise, they may well prove to be a recipe for neglect in the community, which is the genuine fear of all of us who served in Committee. The Government will simply blame housing authorities, social services authorities and the voluntary sector for any failures, although there is grave doubt whether those bodies will be given the resources that they need. Accusations will fly backwards and forwards unless there is a separate local and comprehensive system of monitoring. The CHC has been just such a watchdog in the Health Service and it would be appropriate for the new CHCs to have an expanded role on a more local level to cover care in the community.
The CHC's traditional role in the NHS will become even more important if the Bill becomes law because there will be a need for a local monitoring system to ensure that the Government's promises are kept. Ministers have rejected our criticisms of the indicative drugs budget, practice budgets and the finance-led planning of their new health system. They claim that no patient will lose out, will be struck off the list or go without treatment. If their claims are genuine, they will want the local, effective, monitoring system outlined in the new clause.
I am surprised that the Secretary of State for Wales and his junior Minister have not responded to our suggestion


that the new clause should be accepted as a positive and constructive measure and written into the Bill without the necessity of a long debate.
The new clause sets out to promote the role of CHCs in Wales in several particular ways, based on the special needs of Wales. First, it would enhance the duties of CHCs to advocate on behalf of the users of health and community care services. Secondly, it would co-ordinate such services and discussions about them, particularly community care, at local level. Thirdly, it would monitor such services from the consumer's view and, fourthly, it would communicate its findings to the users of such services at community level.
I emphasise the nature of special needs in Wales. Wales has different and more acute health needs than England. First, more people in Wales develop chronic conditions than in England, particularly young children. Secondly, the male mortality rate is higher in Wales than in England, particularly for heart disease, cerebrovascular disease, bronchitis, emphysema and asthma. The prevalence of disability in Wales is over 20 per cent. higher than in England—even higher than the most severely disabled categories. It seems that the Government do not adequately recognise that.
Many other statistics prove the point, while the reasons for the relatively poor health of people in Wales are well known. They owe a great deal to the industrial and economic history of the Principality. Those differences in health needs call for differences in health care provision. Proportionally more people in Wales visit their doctor more often than in England—particularly young children and people over retirement age. Fewer people in Wales have chosen to make use of private medical insurance. Fewer elderly people in Wales go to make use of private sector homes in retirement, and others are not in a position to exercise any such choice.
A significantly higher proportion of prescriptions in Wales are exempt from payment by virtue of their recipients' financial circumstances than is the case in England. Some important initiatives have taken place in Wales. Heartbeat Wales, launched on St. David's day in 1985, has already achieved much by working with many sectors of the community, including food retailers, industry and the unions. The Lose Weight Wales campaign and several television series have played their part, but the people of Wales, in many unique ways, rely on their National Health Service.
The new clause is partisan in the best sense of the word. It is a serious attempt to maintain the special relationship between the people of Wales and the statutory provision of health and community care. Before moving on to consider the substantive provisions of the clause, I remind the Minister of the commitment that he made elsewhere that he would report as soon as possible on the operation of the joint Welsh Office—National Health Service working group studying the changeover from the steering committee on resource allocation in Wales—the SCRAW formula, which is currently used to determine resource allocation—to the as yet un-named future formula for Wales. The formula contained in the White Paper "Working for Patients" has already been described by the Chartered Association of Certified Accountants as one which
emphasises simplicity possibly to the detriment of equity"—

in the same way as the poll tax perhaps. Simplicity to the detriment of equity characterises the Government's proposals for the community health councils in Wales.
The unique health needs of Wales, the wholly different service delivery structure—I remind hon. Members that Wales has no regional health authority—and the huge internal diversity of population density, persuaded preceding Ministers to develop formulae that allowed investent related to Welsh needs, rather than a statistical abstract devised in England. We should ensure that the same is the case in the future. We have already seen how standard spending assessments for social services spending relate to the needs of particular communities. We do not want that disaster to be visited upon the elderly, the infirm and the sick of Wales once again.
At present there are structural differences in the Health Service in Wales because it has no regional authority. The Welsh Office fulfils the function of that authority. Therefore, in many cases the Secretary of State is judge and jury in his own decision-making.
Wales has several community health councils per district health authority at the moment—two in South Glamorgan, and three or four in most other counties—whereas in England there is one per district health authority. That is an inappropriate structure for Wales. The district health authorities in England cover a smaller area than in Wales where, except in Pembroke, the authority covers the whole county.
The Welsh Office proposes to merge the present community health councils into one per district health authority—one for Mid Glamorgan, one for Clwyd, one for Powys and so on. The maximum number of members for a CHC will be the same as at present—24—so representation will be reduced in every county in Wales, and that is completely unacceptable.
The only argument that the Welsh Office has put forward in favour of a single CHC per district health authority is that it would speak with a single voice on behalf of consumers in the health authority area. Colleagues may reflect that the interests of consumers in Merthyr and Bridgend or Rhyl and Wrexham might be best served by having different voices that are attuned to the specific needs of those communities and the people who live in them.
The suggested parallel with England—where there is one community health council per health authority area—is inappropriate because the population per community health council is much greater in Wales, on the present pattern of community health councils, than is the case in England. It would be totally inappropriate and far worse were the Government's proposals to be followed.
The proposal in the new clause is threefold. First, the number of community health councils should be increased to one per district council area in Wales, thus allowing a strong and more local voice to be heard on behalf of communities. Secondly, a mechanism should be created to allow a joint meeting or a representative meeting on a district health authority-wide basis—again, apart from Pembroke, that means on a county-wide basis—to consider matters on which community health councils want to speak with one voice because they believe it to be in the interests of consumers. Such matters could include the location of district general hospitals and common aspects of the 10-year health authority plan, where it is appropriate that communities throughout the county area should come together to debate the structure.
Thirdly, the role of community health councils should continue to cover Health Service matters but should be extended to cover care in the community, including a joint provision that involves health, social services, voluntary and private organisations, housing and so on. That would provide a much stronger voice for the consumer and the community. It would be locally focused and it would be appropriate to the community-based provision for the elderly, the disabled and the mentally ill that the Government claim that they wish to create.
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If the Bill becomes law, the district health authorities will be run by a small board appointed by the Secretary of State. None of its members will be representative of the community and accountability will disappear. In Wales, the Secretary of State is also the regional health authority and the person who gives resources to the social services authorities, the housing authorities and the voluntary organisations. For there to be any monitoring, accountability or representation of the consumer and the community, it is vital to have the strong community health council structure that the new clause proposes to enable them to undertake the advocate's role on behalf of the consumer and the community.
The Secretary of State has advocated a reduction in the number of community health councils from 22 to nine, but no argument has been advanced for such a reduction. It is not that the Secretary of State is dissatisfied with their work. He acknowledges that the community health councils in Wales
have done much and valuable work in monitoring health care provision and in providing advice and counselling to patients and the public at large.
The Secretary of State's declared aim in his review is to
strengthen and focus the community voice.
How could he say otherwise? The active participation of the consumer is claimed to be an essential part of the proposed reform of the National Health Service that the Bill seeks to establish.
The White Paper "Caring for People" speaks warmly in paragraph 5 of the need at local level to focus attention
on formulating strategic and operational plans to increase participation and choice by service users
There are no practical proposals in the Bill to increase participation and choice by service users. Their participation is reduced and will be virtually removed, unless the Government accept the new clause.
The Secretary of State's consultative paper on quality of care looks forward to the development within the National Health Service directorate in Wales of a "genuinely consumer-oriented organisation." How? The mechanism is not there, unless the new clause is accepted.
The Secretary of State's proposals seek to reduce the number of community health councils and also, by limiting the numbers of members of the reorganised community health councils to the number of members who currently serve on CHCs, to reduce further representation with a consequent reduction in overall community health council membership. My proposal would allow an increase in local representation, yet could allow a modest decrease in the numbers on each community health council. If there is a larger number of community health councils to address the needs of local communities, each can have a slightly smaller membership. They will focus on much more local issues.
We also provide a mechanism to bring people together on a county-wide basis in order to provide a small, representative group—something that, apparently, the Secretary of State wants. Consumer protection is now a recognised social policy objective except, it appears, in the Welsh Office. A wide range of legal measures in both industry and commerce exist to further that objective. Little else, besides the community health councils, exists to cover social welfare. In fact, until the appearance of this new clause in respect of Wales, there were no proposals recognising that need in relation to care in the community.
The report of the panel of inquiry into the future of community health councils, which was prepared by the Association of Community Health Councils, makes the case for the advocacy on behalf of consumers that the new clause seeks to protect. It says:
The crucial difference between consumers of health services and most other consumer groups which requires an active body working on behalf of the former group is that a large number of them are weak and vulnerable and are highly dependent upon the continued receipt of services. This makes it extremely difficult for them to complain personally without support, or to pursue a complaint when the administrative system is less than helpful as is commonly the case.
That in itself is a persuasive sign of the need to build the new clause into the Bill.
Community health councils are specialists in consumer representation and advocacy. Their independence, accessibility, expertise and experience qualify them uniquely to speak on behalf of patients. Therefore, Conservative Members should have no difficulty in supporting the new clause, which further develops the claimed intention of the Bill—to work for patients. They may be further inclined to support the clause when they learn that, of the total National Health Service 1989–90 budget of £19 billion, only some £7 million is to be spent on user representation. I am sure that they agree—I invite the Minister to say that he agrees—that it is wholly unreasonable that a sum equivalent to only 0·035 per cent. of the National Health Service budget is devoted to what they say is such an important tenet of the changes that they are seeking to bring about. If they do not accept the new clause, it will be difficult to believe that they are serious about that.
The new clause sets out to establish a community health council in each district council area—not in each district health authority area, as the Secretary of State has proposed. Such an arrangement would not only provide for better community representation in respect of health matters, but would better reflect the administrative structure of Wales, its unique geography, and the very different problems that can arise within the boundaries of a district health authority. Paragraphs (b) and (c) of the clause would give effect to such an arrangement.
In the case of Powys, the area is more than 100 miles long from north to south. Consider the variety of communities in Gwynedd. Even in the smallest county—South Glamorgan—the last time a Government tried to have one community health council, the proposal was rejected. That is why we have two community health councils. That is why, in the smallest county of Wales, which does not have the geographical problems of many other counties, a change to one community health council would be totally unacceptable.
Paragraph (c) gives to the community health councils the function of co-ordinating the views of relevant voluntary and charitable groups and of the recipients of


community care and other health services and their carers. Those views would be conveyed to the appropriate county and district councils, district health authorities, special health authorities and the Health Service directorate of the Welsh Office, as appropriate. What Member of Parliament for a Welsh constituency would argue that there is not a need for that function? Which of us has not come across the need for the co-ordination of information and for communication with those services and voluntary organisations?
The co-ordination of those involved in care and service delivery is therefore basic to the new clause and, if the Government's claims are to be justified, should be basic to the Bill. Those two paragraphs ensure that, particularly in relation to community care plans, local needs—and I mean local needs, not just needs on a county-wide basis—are effectively identified, and that resources and services, both formal and informal, are put most effectively to use.
I need not rehearse the arguments, which were put forward and largely accepted by the Government in Committee, about the need for full and effective co-ordination of services. However, I should like to illustrate from my own experience how urgent such matters can be and, thus, underline the main message—that the provision of accommodation for the elderly, the disabled and the mentally ill must be arranged to fit with the community care planning by social services authorities, health authorities and voluntary groups. Housing must be taken into account. The district councils and housing associations in an area must be involved, as well as the county council and health authority functions.
In Committee, many examples were given by hon. Members of cases in which resource allocation and quality of provision were important and flexibility was essential. I spoke in Committee of Colin Griffiths, a constituent, who is now tetraplegic following a tragic accident. He is an extremely couragous and extremely independent-minded young man, something in which his parents support and encourage him. He wants to be as independent as he can be—a desire best illustrated by the fact that he wants to help other young adults who face the same problems and encourage them to fight for an independent and full life and a sense of self-worth. When I spoke to him recently, how he could do that exercised his mind more than how his personal needs could be met.
For Colin Griffiths to have the independence to which his courage entitles him, several factors must be fitted together—appropriate housing and day care, help with mechanical aids, transport and so on. As well as guts, this young man has family, Church and community support with which to tackle his position. Tragically, his circumstances are unique, and not all families and communities can offer the same support to the individual.
We have two responsibilities in this case and in many others involving elderly, disabled and mentally ill people in a variety of circumstances. One is to have an efficient and responsive system of health care and care in the community. The second is to make sure that there is an adequate, efficient and local system, which will monitor that provision, give a strong local voice for the consumer and draw together the different ways of providing for individuals in the community and the community as a whole. That is what the new clause is all about.
I draw the Minister's attention to the comments of the National Consumer Council, which also looks at specific examples. The NCC said:

Our recent work with elderly people with dementia and their carers has shown that liaison between health authorities, primary care and social services departments is still, in some areas, poor. This has a detrimental effect on those users who may be in need of help from across the sectors and who would benefit from better and more closely co-ordinated planning.
This demands a mechanism to monitor and review the service provided, and the new clause provides the way to do that in Wales.
It is not sufficient to anticipate a happy and harmonious unregulated relationship developing between the various local, voluntary and health services. It is true that in Wales such co-operation can exist—one thinks of the all-Wales strategy on mental handicap, for example—but there will be new players in the game in future, the private sector providers of health and social care. I am concerned that the Secretary of State seems reluctant in his review to let even the few community health councils that will survive get too close to National Health Service provision.
In the unlikely event of a hospital trust emerging in Wales—I trust that it will continue to be unlikely—the Secretary of State has been careful to point out that a community health council would deal only with a district health authority and not directly with the trust. Moreover, the community health councils would not have an automatic right of access to routine trust meetings or papers. What is the Minister trying to hide? Are such trusts to remain within the NHS, as Ministers keep telling us? In which case, why have this hand-off to the community health councils? If the trusts are to be within the NHS, why should they be accorded such special treatment? There are important functions for the community health councils to undertake.
We come logically to monitoring. Paragraph (d) would ensure that quality is assessed at consumer level. I pay tribute to the high moral tone and the general worthiness of the comments emanating from the Department of Health relating to independent inspection units within districts and the Welsh Office's "Quality Patient Care" document. However, neither mentions the other and both pay little regard to the consumer.
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Let us consider the current position in relation to the work of community health councils. I give the example of North Gwent community health council, the work on which it has reported and its representations to the Secretary of State for Wales recently. It describes its work as follows:
Members undertake regular and frequent visits to all hospitals, clinics, day centres, etc., where they talk to patients and their visitors, and see conditions as they are. This is considered to be the most important and productive aspect of Members' work.
That can be multiplied around every community health council in Wales. The community health council continues:
if there were only one CHC with 24 members to represent the whole of Gwent, it would not be possible to fulfil these visits, and, indeed, much of the time would be spent in travelling the length and breadth of the County. The geography is such that the County is divided by valleys, most of which with a hospital as well as other health care premises. The distance may not look enormous, but in reality, mileage would be considerable…it is considered extremely unlikely that anything like the present levels of visits could be maintained.
Is it really the Minister's intention to reduce that invaluable element in monitoring the Health Service? Will he really refuse the proposition in the new clause that that monitoring be extended to how that health provision


inter-relates with care in the community, such as the social services, housing services and the other services that are needed to give proper provision for people in the community?
The example of North Gwent community health council is not untypical, especially in respect of the independent inspection unit. Do the Government feel entirely happy, despite the arm's length management of such units, that poachers, however reformed, will make the best gamekeepers? The Royal College of Nursing and others have pointed out that the local authority will find itself in a monopoly position on care in the community, with a combination of registration, assessment, procurement and regulatory powers. The community health councils, under the proposals, would provide a meeting place for the noble intentions of the Welsh Office and the independent inspection units of the local authorities, both under the scrutiny of the people who matter most—the patients, the consumers and the community in which they live.
The key point in the communications role of the community health council is as a disseminator of information to people who desparately need accurate and proper information. First, it is difficult to know what services are available. We already see the confusion about that. How does one know that a dog is there if it does not bark? Secondly, it is almost impossible to know what services are available if one does not have direct access to a professional. Thirdly, none of the professionals involved in care in the community has a specific brief to disseminate information and none is required to do so in such a way as to promote access to services. It is only the community health council that can do that. Fourthly, there is after all a proliferation of professionals, all of whom have at best a partial knowledge of the range of services available. Fifthly, most people look for information at a time of crisis. Whether disabled and elderly people receive help depends on their condition, where they live, the structure of the local authority and their luck with professional contacts. We need to guarantee the availability of information as well as services.
The recent report of the King's Fund said:
Methods of getting information to parents about formal care facilities are very inconsistent. It depends very much on local developments and the interest and enthusiasm of individuals and professionals who want to be involved.
The experience in Wales is that the individuals in the community health councils have that enthusiasm and commitment. With no mechanism in any county in Wales to inform professionals of available services, even carers in regular contact with professionals may be unaware of and, therefore, denied access to support services. They are victims of a vicious circle of mutual ignorance and that applies both to health services and to care in the community.
Paragraph (h) is a serious attempt to meet the apparent need of the Secretary of State for a system once more based on simplicity rather than equity. I hope that he will find the paragraph and the rest of the new clause acceptable. That provision would draw together the community health councils, which would be locally based and well informed about their localities so as to hold joint meetings, and thereby achieve the single voice that Ministers want for the consumer and for communities.
The Secretary of State says that he wants a clear, coherent voice for the consumer. That is a nice idea, but it

is not easy to deliver, bearing in mind the danger of oversimplification and distortion. Indeed, it can fairly be said that there is no such thing as a coherent consumer voice. The public at large will always have a variety of views about any topic.
Is it really the role of the CHCs to reconcile those conflicting views, or should they take on the job of ensuring that all expressions of opinion are articulated to the decision-makers in the NHS? Communities will have different interests to be articulated. That is the real meaning of strengthening and focusing the consumer voice. Our proposal in the new clause would achieve that, rather than the half-baked proposal to reduce the number of community health councils in each county.
Strengthening the consumer voice by reducing the number of CHCs in Wales from 22 to nine is a contradiction in terms. There is no evidence that a CHC in a county would give a clearer and stronger focus to the informed consumer voice than does the present pattern of CHCs. Our proposal would strengthen the local element in the representation of the individual and the community.
The new clause would do the job for the Minister because it would strengthen the local community voice and, where needed, create a single voice. It would do what the Minister says he wants to do, and I appeal to him to support it in the interests of consumers and of communities throughout Wales
Until now, health authorities have been run by committees that drew on a mixture of backgrounds, such as medical experts, people elected by the local councils and people appointed by the Welsh Office. In future, much smaller boards will be running the system with fewer medical experts and no local representatives and with all their members being appointed by the Welsh Office. In Wales, unlike in England, we do not have the regional health authority. In future, the budget, policy-making and appointments—all our health authority functions, and much more—will be in the hands of one Minister and his civil servants and there will be no local representation
Where is the voice of the consumer to be heard? How will communities such as Penarth, Merthyr and Bridgend express their views about the type of health services that they need? Who will monitor the way in which the elderly are cared for in the community? Who can listen to the disabled and the mentally ill? The answer is nobody—unless the CHCs can be salvaged from the threat that hangs over them and are made local, effective and coherent, as we propose in the new clause.

Mr. Nicholas Bennett: The hon. Member for Cardiff, South and Penarth (Mr. Michael) said, basically, that community health council areas should be the same as district council areas. It is a pity that he took half an hour to say it.

Mr. Ted Rowlands: We have a national health system, but it is also a local health system, and it is vital for us to bear that in mind. The system originated in local community health care. It 'was from the valley communities that the notion of a national health system was created. We must make sure that we achieve the right balance between a genuine National Health Service and a local health service.
Since those early days we have developed a complex, specialist service which must now be truly national, in Welsh and in British terms. But there is no reason why it cannot be accountable to the community.
As my hon. Friend the Member for Cardiff, South and Penarth (Mr. Michael) said so eloquently—despite a brief and nonsensical interruption from the hon. Member for Pembroke (Mr. Bennett)—the community health councils have been extremely effective. I can only speak from my own experience, but our CHC has certainly been effective. Mr. Bryn Williams has been active and supportive, raising money and also, on occasion, exercising vigilance and being critical of the service. The Government's notion is to take the word "community" out of community health councils, but, with respect, the community of Merthyr and the Cynon Valley is not that of Mid Glamorgan or some grander district.
Throughout the Bill's passage so far, we have debated—rightly, in my view—whether patient power, or consumer power, can be increased. Opposition Members reject the idea that it can be increased through the creation of a false or flawed system of competition, which is at the heart of the Bill. In the communities that I represent there will be only one health system: only one district general hospital, only one practice or group of practices and only one health centre. There will be only one set of arrangements to which those in need can turn. We do not want to create a divisive, competitive system; we believe that the existing system should be made more responsive.
Although we do not need American-style competition between general practices and between hospitals, we cannot be complacent about the current response of the Health Service to people in need. Certainly I am not complacent: I believe that the system must be more sensitive. I want better care and shorter waiting lists for the communities that I represent, and I agree with many of the criticisms. The answer, however, is not to give people the false impression that they can "shop-around"; we need to develop the present system, making it co-operative rather than competitive, and more accountable and sensitive to the community.
In that regard the CHCs have an important role to play. No one is saying that they are perfect; they are an imperfect vehicle to express the views of a community, to pick up its complaints, to apply pressure and at the same time to be active and supportive. The CHC has been described as a local watchdog, but mine is also a great fund-raiser. CHCs have backed the facilities of the Prince Charles hospital, and helped to raise money to produce the finest technology available in the Heads of the Valley. That is one of the major functions of CHCs. We should not destroy their community base. We should develop the system further. I reject the philosophy behind the Bill—the notion that the way to promote patient power is by competition.
As I have said, we need a new regulatory system on behalf of patients, consumers and the community. There is a case for establishing new performance standards at all levels. In a unified Health Service in a community such as I represent there must be standards and performance levels that everyone, from consultants throughout the system, must meet.

3.15 am
The Government have not made that the centrepiece of the Bill because they believe that, in a curious way, competition will deliver that objective, but it will not. The Health Service should be developed by putting more resources into it and it should be made more responsive by establishing new standards and by creating a new regulatory body.
The CHCs could play a vital part in doing just that. The Government's nonsense has no support. The area health authorities, the supposed victims of the CHCs, are against the notion of abolishing them. Whether on the poll tax or education and certainly on health matters and the CHCs, the Government, as always, are on their own. The rest of society rejects them and their proposals.

Mr. Richard Livsey: The rationale behind the Government's and the Welsh Office's thinking on CHCs is to diminish their effectiveness in representing their areas. The proposal in the Welsh Office's consultative paper that the number of CHCs should be reduced from 22 to nine is a direct threat to their effectiveness in representing community interests to the nine district health authorities.
It is important to realise that just when the district health authorities are to be streamlined into a corporate type body with 10 directors, five executive and five non-executive, the CHCs in Wales are being irreparably weakened. All members of the new district health authorities will be appointed rather than elected, and that tells its own story. The communities will no longer be represented on the health authorities. In those circumstances, the community interest will not be protected.
The reduction in the number of the CHCs from 22 to nine and the consequent increase in the area that each CHC covers will fatally weaken the democratic checks and balances in the Health Service in Wales. At present, individual communities are protected by CHCs and new clause 3 will increase the democratic accountability of the Health Service in Wales. The move to reduce the number of CHCs to nine is a cynical and deliberate attempt to undermine the effectiveness of CHCs and the checks and balances.
In Powys, Brecon and Radnor community health council currently has 24 members and Montgomery community health council has 16. The proposals are for one community health council for Powys with 24 members. If we consider that the size of Powys is such that if it were put on its end it would run from the Severn bridge to Hammersmith flyover, we can appreciate that a community health council covering such a distance would be pretty ridiculous. In addition, the population sparsity in Powys—it is unique in that it is the most sparsely populated area in England and Wales by a long way—makes it extremely unlikely that members of the proposed community health council in Powys will know what is going on 130 miles away at the other end of Powys.
If anything is to happen, the special situation in Powys needs recognition, in that it needs at least two community health councils, as at present. If we were to take the new clause to its logical conclusion, there would be three councils—one for Montgomery, one for Radnor and one for Brecon. That would give us proper community representation.
At present, community health council members are often volunteers. Often they cannot spend much of the


week travelling up and down the area—in our case, Powys. They would find it considerably easier under the structure proposed in the new clause.
I make a special plea to the Minister—I have already made one to the Secretary of State. At the very least, Brecon and Radnor community health council and Montgomery community health council should remain in place and separate. That is the only way of effectively monitoring the community needs of the Health Service in Powys. In the present circumstances, an all-Powys CHC is not on.
I have received representations from both community health councils in Powys. They wish to keep the present structure. They are representative of the communities. Given the spread of community hospitals, it is vital that there is someone from each community represented on community health councils. That most certainly will not be the case under the Government's present proposals.
The new clause advocates a CHC for each district, based on the district council boundaries. That would be an effective counterweight to the new corporate style health authorities proposed in the Bill. As for the functions of the CHCs in Wales, the question is whether the standard of health service in their areas is properly monitored. Their acceptability to the public and their ability to represent the users of service when changes are proposed must surely be embodied in a greater number of CHCs than is presently proposed by the Government. The question is whether those functions can be better carried out if the number of CHCs is reduced, which seems unlikely. It might be administratively more efficient to have corresponding areas of CHCs and health authorities—nine of each—but it will be much more difficult for the remaining CHCs to carry out their tasks.
The Government are also begging the question whether it is the CHC numbers that should be changed, not the health authority ones. That issue should be closely examined. If my hon. and learned Friend the Member for Montgomery (Mr. Carlile) is called, he will make that point. In parts of Mid Wales, patients may have problems with a health authority that diverts resources away from their areas. We know that patients leave those areas for treatment in other areas.
The last function—that of representing local users—will be well nigh impossible. The needs of some local users may be very different from those in other communities in the same area. Because health authorities and family health service authorities' memberships are to be streamlined to exclude representatives of the community, as well as the professions, it becomes more important, not less, to strengthen CHCs in their ability to do their job. The Welsh Office envisages that local groups will need to be established. That acknowledges the fact that health authorities cover a range of communities. Why not accept that that is the case and have more CHCs—indeed, a CHC for each district? Local groups will not have the clout of fully-fledged CHCs.
It is impossible to escape from the belief that the Government are concerned with quietening voices critical of the way in which the NHS is run. Many of the Government's proposals, such as NHS trusts and contracts, ignore the patient's voice. Reduced numbers of CDCs would be too over-worked and too unrepresentative to be an active and successful patients' champion. Indeed, where hospital closures are proposed, it is vital for those communities that the CHCs based there can make proper

representations to the health authority to ensure that the interests of the local community are protected. It is unlikely that that will be possible under the new structure. In fact, it may well be a negation of local democracy in relation to the proposed nine CHCs for Wales. It is not a constructive set of proposals, and it is anti-community.

The Parliamentary Under-Secretary of State for Wales (Mr. Ian Grist): It may help the House if I intervene at this stage.
Hon. Members have spoken knowing very well that we issued a consultation document in November and have only just closed the list, although representations are still being received. They have come from most Opposition Members and from others, and we shall carefully consider what we have been told. We take the representations seriously and are not trying to ride roughshod over people's views. Of course, we believe in the proposals that we put forward in that document. We shall set them against any contrary views. Many hon. Members who have spoken have already let my Department know their views, so although they are not being repetitious in the terms of the House, they may be in terms of my office.
We do not propose any change in the primary roles of the CHCs, which will continue to monitor the quality of services provided, to comment on issues relating to changing patterns of NHS services—which, the hon. Member for Brecon and Radnor (Mr. Livsey) will be pleased to hear, includes closure or major changes to service—anything that has a bearing on the welfare of patients and, of course, anything that provides assistance to anyone who encounters difficulties with NHS services.
The purpose behind our proposals, which would include the replacement—it has been depicted as the notorious replacement—of the existing 22 CHCs by nine CHCs is designed to strengthen and focus the voice of the CHCs within each district and to allow them to take a more strategic view of the services for which each district health authority is responsible. Currently, four CHC's in certain areas cannot possibly take a strategic view of the health authority's proposals and activities within that health authority's area. We strongly believe that they are too localised.
We have made our proposals in the belief that the new and larger CHCs, not least because they will be better funded, should make a far more effective contribution on behalf of patients—for example, by expanding their work in areas such as patients' surveys and commenting on quality of work.

Mr. Alex Carlile: How can the Minister say that a community health council which covers 50,000 people and 900 sq miles is too localised? What a load of rubbish.

Mr. Grist: The area health authority of the hon. and learned Gentleman is quite small, as area health authorities go. That is why it does not have a district general hospital in its territory; 50,000 is fewer than the number of inhabitants in my constituency. So I would have said that it was localised.

Mr. Michael: The Minister does not seem to be addressing the fact that various communities have different needs. If he does not want to consider Powys, he should take Mid Glamorgan where there are quite a few


disadvantaged communities. Do not they deserve a voice local enough to focus on their needs? Has he read the new clause to which he is speaking, which offers a way of co-ordinating views at a strategic level within each district health authority area?

Mr. Grist: I think that the hon. Gentleman must have missed my assurance that we are taking the matter extremely seriously and are considering the various points made to us. The points about Mid Glamorgan will be borne very much in mind. He will be aware that there are proposals for the health authority to move its main district general hospital. Therefore, in certain circumstances, with a multiplicity of CHCs, instead of one CHC being responsible for the main district general hospital, wherever it was placed, it would move in and out of different CHCs.

Mr. Michael: The Minister seems not to realise that the health authority will be responsible for the district hospital, and the community health council will be responsible for expressing the views of individuals who live within a specific community. That is what he will destroy if the CHC operates at a county-wide level.

Mr. Grist: Clearly the hon. Gentleman has not appreciated the point that I was making that CHCs are responsible for looking at the delivery of service and the welfare of patients in the hospital structure as well. Therefore, any proposal for closure or major alteration will certainly be of interest to CHCs.
Community health councils should maintain a close link with their local populations. That was precisely why we suggested—it was just a suggestion—that they might choose to establish local working groups on which CHC members might serve, as would other local people. Those would help the CHC to carry out its day-to-day duties.
The proposals contained in the new clause would further fragment the community health council network in Wales. It is ludicrous to suggest having 37 CHCs. The capacity for the CHCs to be able to watch the activities of the area health authority in any strategic sense would be vitiated. I believe that that would damage the interests of patients.

Mr. Alan Williams: Does the Minister accept that there is a genuine difference of opinion? Will he think in different terms to try to understand the point that we are making? Each of the 38 Members representing constituencies in Wales has to carry out on a much wider scale the sort of functions that are carried out in relation to health by the community health councils. I think it would be regarded in Wales as a step backwards—I suspect that the hon. Gentleman would regard it in the same way—if we said that instead of having 38 Members to carry out that function on behalf of all our constituents we should have only nine Members. There can be no pretence that the people of Wales would be better served or that there would be a more localised service. If the hon. Gentleman thinks in those terms, he will see why we are getting angry. We think that he does not understand the personal relationship available through a community health council which my hon. Friend the Member for Cardiff, South and Penarth (Mr. Michael) tried to emphasise.

Mr. Grist: The right hon. Gentleman teases me by suggesting that if we were to follow certain devolutionary principles we might end up with nine Members of Parliament in Wales. That is perhaps worth the consideration of hon. Members. The multiplicity would undermine the ability of the CHCs to take a strategic view of the delivery of health service in their areas and it would complicate the working relationship between them and the district health authorities and the family health service authorities. I am afraid that the new clause would end the existing relationship between the CHCs and FPCs, or the new family health service authorities, as they are to be called.
Even more misplaced is the proposal in the new clause that CHCs should be given a role beyond the NHS in relation to the community care responsibilities of local authorities, including personal social services and complementary housing provision. We have made it clear that in carrying out their community care responsibilities local authorities will have a clear duty to work with health authorities, family health service authorities, housing agencies, voluntary bodies, the private sector and users of services in the development and delivery of community care plans. CHCs will doubtless contribute to that process.
However, we regard as fundamentally misconceived the idea that CHCs should have a statutory role in respect of local authority services. Local authorities are directly accountable to their electorates for the provision of services and they will therefore have the duty of ensuring that users' views about services are adequately taken into account. Indeed, we have made it plain that we shall expect the social services authorities to have in place effective systems for users of services and their representatives to make complaints and representations, as members of the Standing Committee will be aware.
I find unacceptable the idea in the new clause that the CHCs should act as ringmasters for a highly bureaucratic process in attempting what I believe is an impossible task—trying to bring together various voluntary bodies, charitable organisations and others to make them speak with one voice. I do not believe that it is possible to co-ordinate those bodies in the way suggested in the new clause.
As I have said, the formal consultation about the Government's proposals ended on 28 February. We are still analysing the responses. The new clause is flawed in the ways that I have described. It is also untimely with regard to the consultation process that is being undertaken at the moment. I hope that the hon. Member for Cardiff, South and Penarth (Mr. Michael) will withdraw the new clause. If not, I invite the House to reject it.

Dr. Kim Howells: If the Government were to support new clause 3, they would go some way towards regaining a little of the credibility that they have lost during the Bill's passage. That credibility has been lost largely as a result of the Government's refusal to countenance any extension of consultation with those who use and operate the Health Service.
New clause 3 seeks to align community health councils with district councils in Wales and to create a mechanism that would allow meetings of the community health councils to take place on a district health authority-wide basis. I do not understand the Minister's great horror about that arrangement. The proposal that is currently floated by the Welsh Office is that there should be one


CHC per district health authority. In Mid Glamorgan—the county with the highest population in Wales—that would have drastic repercussions for the level of representation through community health councils. Instead of the present four CHCs, the 535,000 inhabitants in Mid Glamorgan would be allocated only one CHC.
Under the new clause Mid Glamorgan's CHCs would increase to six—one for each of the district councils of Cynon Valley, Merthyr Tydfil, Ogwr, Rhondda, Rhymney Valley and Taff-Ely. That population of 500,000 would be subdivided into communities that would vary between 60,000 and 160,000, each with its own characteristics, needs and existing resources.
The Minister knows that there are currently about 30 hospitals servicing the county of Mid Glamorgan. They are located in Rhondda, Taff-Ely, Ogwr, Merthyr, Cynon Valley and Rhymney Valley. Those areas and the health requirements of their population are by no means identical. Mortality and illness rates frequently tend to be higher in the older communities, in the central mining valleys of Rhondda, Cynon Valley and Merthyr, and in the Cyntwell and upper Rhymney valleys, and often much lower in the areas that are contiguous to the M4.
Within just one of those districts—Rhondda and Taff-Ely—considerable sensitivity has to be exercised in administering the needs of an older and declining population in the north of the district and of a younger and growing population in the southern part of the district. The CHC's role in monitoring the quality of health provision, if organised on a district basis, could be much more sensitive than at present. Certain critical variables in each of those areas could be catered for if the provisions were based on a district model which in some ways are not catered for now. I am sure that the Minister is well aware of the difficulties of people in Mid Glamorgan in gaining access to the hospitals, especially to the new district general hospitals, such as the Prince Charles hospital in Merthyr, the East Glamorgan general hospital in the centre and the Princess of Wales hospital in Ogwr. People in many of the areas that are served by those hospitals do not find them easy to get to.
One role of the enhanced model that we are proposing in the new clause would be precisely to allow the monitoring service to inform the public of the new arrangements affecting the district general hospitals, such as the new one that I hope will be built to serve the Taff-Ely and Rhondda areas. That would allow much more sensitivity and the input of greater local knowledge about access and people's ability to get to those hospitals. In that way, it would become much more of a two-way process. The decisions would not be being made in county hall, which might not be as sensitive as it should be to the peculiar topography and geography of the valleys in south Wales. It is not asking a great deal to ask that the potential of the expertise of local voices should be tapped by any new arrangement. That local voice should not be diminished by making the decisions more remote in terms of the lack of input of local expertise and information. The Minister seems to be over-reacting dramatically to what is simply an extension of consultation and of people's access to those decisions and the way in which they are made.
I congratulate my hon. Friend the Member for Cardiff, South and Penarth (Mr. Michael) on the way in which he moved the new clause. He has rightly highlighted and valued something about Wales that is unique—our

identification with communities. That is something that we should treasure and look after. I advise Ministers that the new clause does just that.

Mr. Ieuan Wyn Jones: In supporting new clause 3, may I say that we are discussing the important principle of the way in which community health councils can fulfil their primary role as a public watchdog. We are doing so against the background of a Bill that seeks to reduce the accountability of the district health authorities and all the other bodies that will administer the Health Service in Wales. The Minister will be aware of the criticism of Opposition Members in Committee about the way in which the new constitution of district health authorities and family health service authorities was being radically changed to introduce what the White Paper, but not the Bill, calls a more businesslike approach. In other words, they are being changed to make district health authorities run like businesses and to reduce accountability and the representation of local authorities on those bodies. The accountability and the effectiveness of the body would be reduced. The Government cannot have it all ways
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We must make it clear, and the British Medical Association has informed us in its briefing for the debate, that there is widespread opposition to the Government's plans. That widespread opposition must be articulated in a democracy. The people of Wales have rejected time and again the philosophy of change in the Bill. If that is the case, the Government could at least give us an effective watchdog to ensure that the health changes that are being pushed through in the Bill are effectively monitored. That is an honourable argument for Opposition Members to put. There should be an effective monitoring arrangement and system.
The Minister sought to persuade us that, by making each community health council conterminous with the district health authority, he would make them more effective because they would monitor the same area and could make strategic decisions. But the people whom CHCs seek to represent do not see it that way. I inform the Minister, in common with my hon. Friends who have spoken for Mid Glamorgan, South Glamorgan and Powys, that the people of Gwynedd reject the plan for the basic reason that, as my hon. Friend the Member for Merthyr Tydfil and Rhymney (Mr. Rowlands) said, community health councils surely must be based at community level to make sense. That is the way that the people of Ynys Môn see it.
I am in the unique position of speaking for a people who live on an island. They know the sense of community that that involves. They reject the principle that their views should be taken into account in a wider context, particularly being an island people. The people of Anglesey are angry that their CHC is to be abolished under the Bill.
We must also consider the geographical areas which the CHCs, as envisaged by the Welsh Office, would cover. We have heard about the problems of Mid Glamorgan, South Glamorgan and Powys, and I can talk about the problems of Gwynedd. It would be intolerable if we had community health councils which sought to represent the views of people on a county-wide basis. What involves people in articulating their views is what happens to them in their communities. It is not what happens at the other end of the


county; it is what happens to their hospital, doctors, friends and relatives. They can empathise with their colleagues and friends within their own villages. They cannot do so with people who live on the other side of the county.

Mr. Grist: Does the hon. Gentleman suggest that patients who go to ysbyty Gwynedd would have to be represented by their home CHC? Or does he think that an overall CHC could better track from home to hospital the complaint or worry of a person from Holyhead who goes to ysbyty Gwynedd? Surely that would be better than if the responsibility were split between two CHCs. That is our argument.

Mr. Jones: I was coming to my next point, which is that the management structure of Gwynedd district health authority is unique in being based not on discipline but on geographical areas.

Mr. Michael: Does my hon. Friend agree that the Minister's intervention seems inappropriate to the new clause because the new clause would provide consideration of the needs of the individual community and co-ordination between CHCs? I hope that the proposals for the break-up of the structure within Gwynedd health authority will not go ahead because that would remove the link between management and local communities.

Mr. Jones: Absolutely right. My hon. Friend makes his point effectively.
There could be an improvement in the management structure of Gwynedd health authority. The Minister knows that I have been highly critical of its operations in recent years. Where management is based on geographical breakdown rather than on discipline, there is a case for having CHCs for each geographical area within the county. The Government constantly tell us that we should put the patient first. If the patient is to be rooted in a community and the voice of that community is to be articulated, it should be under a smaller system of CHCs.
One of the new structures created by the Bill is NHS trusts. God forbid that any operate in Wales. I am not aware of any hospital that has announced that it wishes to seek trust status. If one did, the danger is that other district general hospitals may find that they cannot provide the comprehensive health care which they are obliged to provide under statute because of a lack of resources and they may wish to buy in services from neighbouring authorities. We need CHCs locally to consider that.
In fairness I should say to the House that I was impressed with the lobby which the Welsh Association of Community Health Councils organised a few weeks ago. Its message—each CHC area in Wales was represented—was that the Government's plans would be detrimental to the monitoring of the Health Service in Wales and that the measures contained in the Bill would not lead to better services. Therefore, it is vital to have an effective local watchdog.
I am not aware of any body, person or organisation that has expressed support for the Welsh Office proposals in its consultation document. If the Minister were to reply again, perhaps he could tell us whether, as a result of the consultation procedure, any body, organisation or group of persons representing the Health Service in Wales supports his proposals.

Mr. Alex Carlile: I listened without surprise, but with accustomed dismay, to the earlier interventions of the Minister. They have confirmed the worst suspicions of people who live in rural Wales.
Apparently, Welsh Office Ministers still consider Wales to be a small place somewhere near Cardiff. As a Member representing a rural constituency, it seems that Montgomery is simply being cast into the Cardiff mould for the decision-making on community health councils. It is too far north for community considerations to be bothered with.
When the Secretary of State limps out of the Welsh Office he will leave quite a legacy behind him—the county councils, which he was responsible for creating during the previous Conservative Government, and which nobody in rural Wales ever wanted. The Government usually find that when a new authority is created eventually people get used to it, and they acquiesce in its existence and get on with the job. However, 16 years after the creation of the new Welsh counties we still do not want them, and we have not got used to them. It is offensive to the people of mid-Wales to have further community facilities and democratic accountability—if there is any accountability in this—ascribed to the same level as those unwanted county councils. When the Secretary of State leaves office we shall still have his unwanted county councils and our representation in health matters in mid-Wales will have been reduced to the same poor level.
In the early part of the 1980s, the Boundary Commission for Wales made a provisional recommendation that the seat which I represent and the constituency of my hon. Friend the Member for Brecon and Radnor (Mr. Livsey) should be merged to form a single Powys seat. There was a detailed hearing of the merits of that before a deputy boundary commissioner, Mr. David Glyn Morgan. After careful consideration of the evidence, Mr. Glyn Morgan came to the sensible conclusion that it was absurd to combine the communities of Montgomery—the old county of Montgomeryshire—and Brecon and Radnor. Why did he come to that conclusion? Because he could see that they are two distinctive communities which require distinctive representation; two geographical areas; two traditional community areas, with traditional community ties; two disparate communities. Therefore, he recommeded, and the Boundary Commission for Wales accepted, that there should be two separate constituencies. Exactly the same arguments apply to the number of community health councils in Powys.
It is a particularly stark fact for the people of Montgomeryshire that we are not as well served by the National Health Service as other areas. We have no district general hospital. Every patient who requires acute treatment has to go elsewhere to a district general hospital—and not to just one but to one of a selection—perhaps in Shrewsbury, Aberystwyth, South Powys, Hereford or Wrexham. It is ridiculous to suggest that a Powys community health council—bearing in mind what my hon. Friend the Member for Brecon and Radnor said about the size of Powys—could scrutinise the adequacy of health services made available to people in my constituency. It is likely to lead to a decline in accountability. We know what the Government are up to in their proposals concerning public bodies in Wales. They are reducing their size. In some cases that may have merit. However, they are being


reduced in size so that the Government can carefully put into place those who sympathise with their political views. That is a recipe for patronage.
Wales has been riddled with patronage for at least 80 years. It is time that there was a little less patronage in Wales and a little more democratic accountability. The putting in place of a few Tory business men and business women will not satisfy the people of mid-Wales.

Mr. Grist: If the hon. and learned Gentleman looks at the consultation document, he will see that we have left the appointments system exactly the same as it is at present.

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Mr. Carlile: That is a joke and a half. Of course, the Government have left the patronage system as it is at present, but it will be much easier to find six or nine Tory business men than 32 or 34 Tory business men. It will be jolly easy, thank you very much, to pick out the chosen few—the chairmen of the Conservative associations and so on—to fill these jobs. If ever there were a bit of obvious cynical politicking, this is it.
From our viewpoint in mid-Wales—it is a special viewpoint, for the reason I mentioned: that there is no district general hospital within my constituency—it is high time that the Welsh Office recognised the need, which many have spoken of in the past, for a new mid-Wales health authority and for community health councils to be based on the very large district council areas that already exist. I mentioned earlier in the debate the size of my own area. That seems to me as large as one community health council can cover and manage. I pay tribute to the work that has been done in the past by my constituency's community health council. I deplore its passing.
My hon. Friend the Member for Brecon and Radnor was right to refer to the need for checks and balances. The trouble is that the Government do not care about the balances. All that they care about are the cheques—not the kind of checks to which my hon. Friend referred.

Mr. Rhodri Morgan: I intend to refer to the problems that constituencies will face if the Government do not accept new clause 3. It attempts to ensure that the community health councils will be able to look after consumers in our constituencies and provide the services that the National Health Service is supposed to deliver.
My constituency will need to call on the services of the community health council in Cardiff. The result of the severe underfunding of the South Glamorgan regional health authority is that it now proposes to close six hospitals, three of them in my constituency—one large and two small hospitals. St. David's is the large one; Glan Ely and the Ely ear, nose and throat hospital for children are the two small ones. The proposal is to close them during the coming financial year.
According to the document that was made public in February by the South Glamorgan regional health authority, consultations will be held on the closure of those hospitals immediately after 1 April. The community health council will take part in the consultations. The Minister said earlier, "If we have countywide community health councils, they will be able to take a more strategic line." That means that they would fit in with the regional health authority's thinking. They would not be so effective in representing the interests of the consumer. They would

be able to understand what the management had in mind. They could be persuaded that the offer being made by the health authority—"We shall close down these six hospitals, reorganise the service and reduce the number of beds", and so on—was understandable. Being on the same strategic plane, they would be able to see that the health authority was doing the right thing. Of course, in reality, the Government are reacting to a severe underfunding crisis in South Glamorgan—underfunding to the extent of £7·5 million. They are closing hospitals so that the land on which they stand may be sold. In other words, revenue underfunding in the county is being made good by the sale of capital assets.
The type of problem that we in South Glamorgan face as a result of this clash with patient or consumer thinking is illustrated by the seminar that the NHS in Wales is organising this summer for the purpose of inculcating what it calls management thinking. It will be a wonderful seminar. It is being commended by John Wyn Owen, the director of the NHS in Wales. Indeed, the director has almost threatened that everybody involved in the NHS in Wales ought to attend. In the leaflet of invitation that was sent out on behalf of the NHS in Wales and the Yale university school of management he says:
The need for the organisational development and the use of different management methods brought about by the
White Paper"—
the White Paper "Working for Patients", not legislation—
has made the programme of even greater relevance and interest at this time. I unreservedly commend it to you and look forward to seeing colleagues at this event.

Mr. Win Griffiths: Does my hon. Friend agree that this is a serious waste of paper? As American health costs are two or three times those in the British Health Service, it is unlikely that the Yale university school of management will be able to offer us any advice on the provision of patient care at low cost.

Mr. Morgan: I could not agree more. The cost of this seminar in Llandrindod Wells will be £1,500 per person attending. How many holidays in Llandrindod Wells could one normally get for £1,500? In addition, there is £225 VAT. This is to enable people from Yale to teach us something. But, as my hon. Friend says, in terms of National Health Service administration costs, we could teach them something. We could teach these professors from the Yale university how to run a health care system with very low administrative costs. The NHS in Wales is trying to inculcate this sort of management bunkum, whereas what we want is more money for the system. We do not want whiz-kids uttering buzz words; we want more medics delivering health care. Unfortunately, the elimination of community health councils will hardly help. It will lead to a culture in which management methods are finance-oriented—a culture in which, in the end, health care systems work for profit rather than for patient care. We need community-based CHCs to prevent that.
I listened very carefully to the Minister's remarks. I always find myself accepting that he is very sincere. He has an outgoing personality. If the electors of Cardiff, Central have anything to do with it, we shall discover at the next election just what an outgoing Member of Parliament he is. We in Wales do not want a transatlantic takeover. We do not want to be deprived of the ability adequately to resist the closure of hospitals. We want to be able to put forward the case for keeping the hospitals that we have. We do not want to see Ministers indicating to senior


management staff of the NHS in Wales that we are heading for a finance-oriented system full of accountants and involving lots of expenditure on management conferences and new computer systems. We want a system whereby the CHC at community level represents the interests of the ordinary consumers of the NHS. If they want hospitals to remain open that the management wants to close, they should have the right to put their case as effectively as they can.
If the Minister thinks that he can get South Glamorgan health authority to close St. David's easily, he has another think coming. There will be an almighty row. We are not willing to accept that, suddenly, because of revenue shortfalls, health authorities will be panicked into making short-term hospital closure decisions. That will be the rocky road to ruin. It will mean that health authorities are left with no alternative but to sell their capital assets to make good the shortfall in money that the Government should provide.

Mr. Win Griffiths: We have had quite an interesting debate in the early hours of the morning. If we look at the Government's proposals once again—heaven knows, we have done so often enough—we see that they are based on a theory that has already been discredited in practice in many countries. In the United States, Switzerland, France and Germany, where there is much more of this so-called competition, average health costs are double those in the United Kingdom. The Government wish to bring into our Health Service market principles that are supposed to make the service more cost-effective and more sensitive to consumers' needs, but no health service in the world can support those claims.
On the basis of that discredited theory, the Welsh Office has already agreed to inject an additional £5 million into the Health Service to provide it with the information technology needed to enable the market system to operate. If the Government genuinely want to ensure that the new system is sensitive to the user's needs, a substantial increase will be needed in the resources made available to the community health councils. They are the statutory bodies charged with representing user and community interests in the NHS.
Instead, there has been a Welsh Office consultation paper in which the Secretary of State for Wales proposes to reduce the number of CHCs from 22 to nine. The Minister suggested that the Welsh Office would listen to all the responses, but he suggested also that our new clause, which is much more along the lines of the existing system than is the Government's proposal, is not to be countenanced. It seems as though the issue has been prejudged and that this is a deliberate attempt by the Welsh Office to remove a genuine local focus for anxieties about the NHS in Wales.
My CHC in the Ogwr district of Mid Glamorgan, which is superbly serviced by Mr. Chris Johnson, its secretary, does a tremendous job monitoring developments. There is no way that that CHC, translated into the county of Mid Glamorgan with the same number of people, could possibly monitor the entire Health Service in the county; it is out of the question. I hope that the Minister, in reviewing the responses he has received, comes to realise that that is the virtually unanimous opinion of all the people and all the organisations that have responded.
Under the proposals, this extremely good community health council is destined to be swallowed, along with the three other community health councils in Mid Glamorgan, into one body with the same number of members—24. It cannot do the same job across the county as each of the present councils does in one district of Mid Glamorgan now.
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In competitive business, commercial companies often take steps to ensure consumer satisfaction. There may be a move towards encouraging district health authorities, family health service authorities and service providers to assume more responsibility in this area themselves. However, in the commercial world, it is in the interests of the providers of goods and services to undertake that work in an objective manner. One cannot get such work done in the same way within the structure of a health authority. Patients do not have the same purchasing power as consumers have in the outside world. The two cannot be equated. In the National Health Service, purchasing power will lie with the procurers of the service, such as the district health authorities and the GPs who hold their own clinical budgets, rather than with the patients or the public at large. The imperative for the service providers will be to satisfy health authorities and GPs rather than patients. If patients benefit, it will only be by chance.
Community health councils as statutory and independent bodies must be recognised as having a primary responsibility for insisting on and measuring user satisfaction. They must be properly resourced to enable them to undertake that task effectively. Much of that input depends on the work of volunteers within the structure of community health councils. To imagine that the 24 good men and women will be ranged up and down the county of Mid Glamorgan—and this will be even less true of counties such as Powys—is to place a responsibility on them which cannot be sustained. We must look to community health councils that genuinely represent communities. Perhaps the Government do not fully appreciate that the councils are not only good at the provision of information, advice and assistance to individual members of the public, but are often the only groups performing such a task across the whole area of a health authority.
That part of CHCs' work is likely to increase substantially with the more complex pattern of services that the Government intend to introduce through the Bill. The Government are, unfortunately, seeking to introduce a far more market-style National Health Service. They will reduce the number of people who will provide an information service to patients seeking help in the Health Service. So far, community health councils in Wales have done an extremely good job with minimal resources. I should like the Welsh Office to review their work to see how it could be done more effectively, but merely to make a proposal to cut the numbers is wholly out of keeping with any form of providing an improved service.
The consultative document issued by the Welsh Office gives no confidence to the public that the CHCs will be able to do the job better when their numbers are slashed. The Department should accept that the CHCs will be even more important as part of the complex system that is being introduced.
Should the Bill pass unamended, we will move first to the commercialisation of the NHS and then to its


privatisation. In other words, this measure represents the first step towards the privatisation that the Government are trying to avoid having tagged on to them. The public at large know that that will happen, and it worries them.
The type of care that will be provided will be a precursor of what is now happening in America. We must face the fact that the more we introduce competition and the concept of cost-effectiveness in patient care, the sooner that American type of care will be on our doorsteps. Patients will become customers, cash will be king, cost-cutting will have a greater priority than patient care and access to treatment will be enhanced by personal payments.
The Government frequently say that they are spending more on the NHS. They are hiding behind the facade of the retail prices index, which has no relationship to the real cost of providing health care and meeting the expanding needs of the NHS, faced with our aging population.

Mr. Grist: I have been listening to this farrago for long enough—[Interruption.] The hon. Gentleman will appreciate that the vast bulk of the cost of the NHS is made up of pay, which is set against the cost of living index and therefore has a direct bearing on that index. Health authorities do not pay mortgages, which feature largely in the cost of living index. In other words, those issues have a great effect on the index.

Mr. Deputy Speaker (Mr. Harold Walker): Order. All of that is a considerable distance from the substance of the new clause that is being debated.

Mr. Griffiths: Community health councils play an important role in seeing that health authorities are properly funded so that patients get the care they need. Despite the Government's claims about putting extra money into the NHS, hospital waiting lists continue to lengthen and, because of the aging population and the stress that many people face due to high unemployment and more costly mortgages, greater use is being made of the NHS.
Not for the first time, I was confronted this week with a case that many other hon. Members will have faced. An old-age pensioner telephoned me almost in tears saying that he had been discharged from hospital into his home without anybody to look after him. He said he could not cope and was feeling unwell. I had to contact the health authority and social services to ensure that that old gentleman was not left to his own devices.
Such people are not being pushed out of hospital because they are considered to be well enough to manage on their own; they are having to leave to make beds available for others who are seriously ill. The CHCs, by monitoring developments of that kind, can highlight the need for a better-funded Health Service.
Why are health authorities in Wales—and, indeed, all over the country—crying out for cash for patients, when operations are being rationed? At Christmas last year, the Princess of Wales hospital in my constituency stopped all non-urgent operations for three weeks when waiting lists were growing. That is a scandal, and the Bill does nothing to deal with it.

Mr. Alan Williams: I did not intend to speak, but I want to respond to one or two points made by the Minister. As he knows from my experience with my local health authority—he has been of great assistance in that regard

—I have as great an interest as he has in devising an effective method of controlling what could otherwise be arrogant and arbitrary authorities, although we may disagree on how that is to be achieved. There is no health authority in Wales more arrogant or arbitrary than that in West Glamorgan, as the Minister knows from the case of the Singleton casualty unit. We start from the same premise: we want an effective monitoring system that represents public interests vis-a-vis the policy decisions made by health authorities.
Nevertheless, I find it somewhat worrying—indeed, virtually grotesque—that a Bill that will change the system more drastically than it has been changed since the Health Service was established, so that even doctors are afraid that patients will be rendered into units of account by the budgetary system for GPs and the best-buy approach towards hospitals, also does something very different: it releases into that depersonalised system the very people who are least able to fend for themselves.
As a barrister, the Secretary of State for Health will remember—as will some of my hon. Friends—that, when the House first debated the abolition of the death sentence, one of the arguments against a life sentence of more than 10 years was that people who had served a sentence of 10 years or more became institutionalised. A week ago, a gentleman came to my surgery having just spent 30 years in a series of mental institutions. Now, in the community, he will have to survive as an individual, against the changing background that the Government are trying to introduce. He will find himself desperately dependent.
The Minister said that there would be no alteration in the CHCs' primary role of monitoring the changing pattern of the NHS. As I have said, however, this is a time of the most rapid change since the establishment of the service. As my hon. Friends have said, at the very time when monitoring is most needed—particularly in rural areas—it is being reduced. We are in danger of making the CHCs more inaccessible, not more accessible; more remote, not more available; and more difficult to find and approach.
4.30 am
Sitting alongside the Under-Secretary of State is the Secretary of State for Health, who has not enjoyed the greatest of eulogies in the past few months. But he at least is creating smaller CHCs in England than his colleague is seeking to impose on Wales. The Government are reducing the number of CHCs from 22 to nine, at the same time as they are halving the number of people who will be involved in them, and so halving the number of people available to the public and to carry out the very monitoring that he has admitted remains their primary role.
The Under-Secretary must ask himself how CHCs will achieve their primary function on much diminished individual resources. There just is not the manpower. There is no logic, other than on paper, in saying that there should be one CHC for each health authority. In Wales, except in Dyfed, the Minister is saying that there should be one CHC per county. If that is what he wants, it would be more logical—but not necessarily the best thing to do—to say that rather than create a special quango we already have representative organisations at county level. They are called councils. If he thinks that a county basis is correct, a machinery already exists that is more democratic than the one that he is seeking to impose.

Mr. Grist: The right hon. Gentleman will appreciate that we are not proposing to cut the amount of money going to CHCs. Therefore, the nine that we propose would be better resourced and so better able to carry out such work as patient surveys, which they may find beyond them at the moment. There is a pay-off there. It is difficult to know how 37 would be financed, particularly with a standstill on overall finances.

Mr. Williams: The Minister says that he will halve the number of people and give them the same resource. If he is cutting back on the number of people, it would be logical to increase the resource in order to enable the smaller number of people to use more up-to-date techniques to achieve his and our objectives.

Mr. Grist: The right hon. Gentleman seems to have misunderstood me. The same amount of money will be given to a smaller number, so they will have more money available.

Mr. Williams: But the point is that it is the same money, not more money. Therefore, the financial resource is the same. There are just fewer people to use it and to take advanatage of it. But the Minister does not understand that. That is where he has gone wrong. I hope that he will listen instead of laughing.
The Minister said at the outset that he approached the debate in an open-minded manner, but he does not give that impression and I am saddened by that. This need not be a point of great principle between the two sides. If there is genuine consultation, he should be willing to listen and not take a pre-set position. He should not sneer when someone is putting forward an argument in a reasonable way. I could make a completely different speech, which I would much more enjoy giving and which the hon. Gentleman would much less enjoy listening to, if I wanted to make a political speech. Atypically, I have tried to be eminently reasonable in the debate with the Minister and his colleagues.
The Minister started at the wrong end. He talked of bureaucracy but he brought to us a plan drawn up by bureaucrats for bureaucrats. He started with the system instead of with the people. He should have started not with the number of individual health authorities, but with the 2·5 million patients. He should have asked himself, "What is the correct structure to enable the interests of 2·5 million people to be properly monitored, sounded and represented by and to the health authorities and the Welsh Office?"
The Minister should remember that we are talking not just about policy decisions, but about monitoring local implementation and the results of those decisions. That is what matters to our constituents. That is why I said that he started at the wrong end. I return to the parallel that I put to him earlier; I am not suggesting that there should be 38 councils. He seemed to misunderstand my point.
There is a parallel to be drawn. In Wales we have 38 Members of Parliament, representing 2·5 million people. Does the Minister seriously think that we would do our job more effectively if we each represented two or three times as many constituents as we do at present? If he thinks of his surgery and daily caseload, does he seriously believe that he would do the job more effectively if he was responsible for two or three constituencies? That is what he is saying about the health councils. He wants them to become more remote and more difficult for the public to

get to, yet they are supposed to be more representative. He is actually creating the reverse of what, I am sure, he genuinely wants to produce.
Will the Minister not be set and predetermined in his responses? There will be no crowing from the Oppositon if he says, "We have listened to the arguments and we think that some of the points that you have made were right. We reject other points, but on this particular point we think that the Opposition—not just as a party sitting on the Benches, but people in Wales, including the doctors, those in the Health Service, and the patients—are right. We acknowledge that we put forward a proposal in good faith, but on analysis it has proved to be wrong. Therefore, we shall be big enough to step back".

Mr. Michael: I had hoped that the Minister would respond to the generous invitation of my right hon. Friend the Member for Swansea, West (Mr. Williams) who was right to point out where the attention should be focused in this debate and to suggest that the Minister should start with the people, patients and the communities in which they live. That is what the debate is about and what the Minister has simply not understood.
Conservative Members have failed to respond to a constructive proposal. It is deeply disappointing that the Minister has been so negative. The Conservative party, generally, has been pathetic in this debate. We had a single sentence from the hon. Member for Pembroke (Mr. Bennett), who has otherwise been conspicuous by his absence. Apart from that, the Minister has been the single, lonely Conservative Member, rejecting the one opportunity open to him to build into this deeply unpopular and dangerous experiment with our National Health Service in Wales the representative of consumers in the community. As a Cardiff Member, I am ashamed of the Minister's response. The city of Cardiff, like every other community in Wales, rejects his plan and needs the new clause. His majority is not very large, so he will not be in the House much longer.
The Minister suggested that the CHCs—and there will be fewer of them—would be better resourced. They have an impossible task. The hon. Gentleman is trying to emasculate them and largely to eliminate the voluntary commitment that they attract and on which their work depends. I was amazed to hear his extraordinary claim that the new clause would fragment the community health services in Wales. That is complete nonsense because it is his proposals that will destroy them.
I regret that the Minister demonstrated his ignorance of the commitment and effectiveness of people in the local community if they are supported and encouraged to help a service in which they believe. The new clause offers a mechanism to co-ordinate the views of the more local CHCs that the hon. Gentleman proposes so that, where appropriate, a single view can be expressed across a county or district health authority area. That mechanism is built into the new clause, so why is the Minister rejecting it?
The Minister suggested that the link between the CHCs and what are now called family health service committees would be removed. That is untrue. The hon. Gentleman could not have read the clause. Paragraph (a) states:
shall assume in its area, such responsibilities and duties in relation to health matters and services as are undertaken by the existing Community Health Councils.
No element in the work of the existing CHCs will be removed if the new clause is accepted. It involves representation in the development of plans within a county


council area because care in the community cannot simply be carried out by the local authority. We cannot ignore the overlap between the social services department, the health authority, the housing department and so on.
The new clause is an intensely practical recommendation. The Minister's response is impractical because he ignores what is done by CHCs—the regular and frequent visits to all hospitals, clinics and day centres; the fact that members of existing CHCs talk to patients and their visitors; the fact that they see conditions in Health Service provision as they are. That is what we want on a more local basis, taking into account the development of care in the community, and co-ordinated countrywide to provide the single, coherent voice that the Minister says that he wants.
I regret that I have to conclude from the debate that the Minister does not believe in giving the consumer a voice; that he does not believe in co-ordinating services in a way that involves the community; that he does not understand how communities tick. He has proposed a plan that will render the representation of the consumer in the community meaningless, and he had better think again.

Question put, That the clause be read a Second time:—

The House divided: Ayes 55, Noes 140.

Question accordingly negatived.

New clause 4

CONSULTATION ON NATIONAL HEALTH SERVICE TRUSTS

(1) Before making an Order under section 5 of this Act the Secretary of State shall lay before Parliament a report.

(2) A report under subsection (1) above shall state:
(a) The results of a ballot of staff at the hospital or service applying for Trust status.
(b) In any case where a majority of the patients of the hospital or service reside in a single borough or district council, the result of a ballot of electors registered in that local authority area.
(c) The views of any relevant District Health Authority or health board in Scotland.
(d) The views of any relevant Community Health Council.

(3) The Secretary of State shall not approve application for a National Health Trust until a report under this section is approved by both Houses.'—(Mr. Robin Cook.]

Brought up, and read the First time.

Mr. Robin Cook: I beg to move, That the clause be read a Second time.
We now come to the heart of the Bill and of the Government's proposals. The new clause relates to the proposal that the Government were good enough to refer to as one of their key propositions—the creation of self-governing trusts. That matter has given rise to strong views both for and against, and I am therefore happy to assure the House that this is not an occasion on which it is necessary for me to strike a non-partisan note. I have strong views on this matter. I believe that self-governing trusts will result in the fragmentation of the Health Service, that the competition on which they are based will introduce a commercial ethos into the Health Service, and that they are patently designed to pave the way for the privatisation of the Health Service.
I am aware that Conservative Members take a different view. Some take the view that this will be an excellent change for the Health Service. The Secretary of State's predecessor proposed that the changes would be the greatest breakthrough in medicine since the discovery of penicillin, but I doubt whether many hon. Members would wish to go that far.
Whichever view hon. Members take on whether self-governing trusts are desirable, there can be agreement on both sides that that step is a major decision for the local Health Service. The contention of new clause 4 is that that decision should be taken by local people. I am happy to say that the Secretary of State seems to agree with that proposition. At an early stage during the debate on the White Paper, he made a speech on self-governing hospitals which was videoed and included on the staff communications video. These are the words of the right hon. and learned Gentleman in that message which was so expensively prepared for the staff of hospitals contemplating self-governing status:
I believe the best decisions on local services are the ones made by doctors, nurses and managers who have first-hand knowledge of the needs of local people.
That is a sensible basis on which to proceed.
However, I am sorry to report that, ever since we took the Secretary of State at his word, he has been desperately inventing arguments about why this local decision could not be left to local people. The Bill makes it perfectly clear who is intended to take that "local" decision. Clause 5 opens with the deathless line:
The Secretary of State may by order establish bodies, to be known as National Health Service trusts".
It also states that the Secretary of State shall also appoint the board of directors of the trust, and
The functions specified in an order…shall include such functions as the Secretary of State considers appropriate…
The Secretary of State may by regulations make general provision with respect to—
(a) the qualifications for and the tenure of office of the chairman and directors of an NHS trust…
(b) the persons by whom the directors and any of the officers are to be appointed and the manner of their appointment
(c) the maximum and minimum numbers of the directors;
(d) the proceedings of the trust; and
(e) the appointment, constitution and exercise of functions by committees and sub-committees of the trust".
All those things will be established in regulations that are to be decided by the Secretary of State. It is perfectly clear that it will not be left to the local people to decide

whether they shall have an NHS trust, nor even what that NHS trust shall do. There is nothing in the Bill to oblige the Secretary of State, when deciding whether to create an NHS trust, to produce a single scrap of evidence that it is supported by the people who work in that hospital or those who use it.
That is why I have tabled a new clause 4, which would oblige the Secretary of State to report to the House before approving an order for an NHS trust on the views of three seperate groups that are most closely affected—all of them local people. The first of the three groups comprises the patients of the hospital. They come from the population of the catchment area of the hospital or unit concerned. I am conscious that the formula that I have proposed in the new clause will not fit every case on the list that is proposed for self-governing status. However, it will fit the majority—a point which I shall develop later.
Why should patients worry about the creation of National Health Service trusts? Why should they seek the right to ballot on the creation of a trust? The first reason is that trusts will be obliged to trade on their own account. Working paper No. I on self-governing hospitals is refreshingly candid on that point. On page 8 we find in paragraph 2.2 the following candid statement on how various hospitals or units are expected to balance their books:
The main source of revenue will be from contracts with health authorities to provide their residents with specified NHS services to a given level and quality of service. Other contracts may come from general practitioner practices or private patients
—a point to which I shall return. The moment that a hospital or unit finds that it is dependent for income on trading on contracts, it has entered into a commercial environment in which the directors who run the hospital will be obliged and have a duty to secure its financial viability before medical needs can be fulfilled.

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Mr. Kenneth Clarke: I am following the hon. Gentleman with great care. The passage that he quoted would apply to every hospital in the NHS, whether self-governing or directly managed. I am not sure why the quote from working paper No. 1 gives a key reason why self-governing status should be the subject of the ballot that he proposes.

Mr. Cook: I welcome that intervention, which I anticipated. The Secretary of State has just confirmed that not only self-governing trust hospitals will enter into a commercial ethos, but every hospital in th Health Service will find itself in a competitive and commercial environment.
The reason why I believe that patients in a catchment area where there is a proposal to create a trust should be anxious is that the moment that the hospital becomes self-governing it will be outwith the scope of the district health authority. It will no longer be directly managed by the district health authority. In the case of several district health authorities, to which I shall refer later, hospitals will have acquired self-governing status in defiance of the wishes of the district health authority. Hospitals may find that the district health authority does not have the loyalty and commitment to making it a success that it has to those which it directly manages.
If hon. Members have any doubts about how swiftly and dramatically the new environment would encourage a


commercial ethos within the hospital sector, they need only glimpse the documents currently being prepared by hospitals contemplating forming an NHS trust. I have found it depressing how quickly the language of public service has been replaced by the patter of the salesman. The most remarkable is the document produced by Yorkshire region. It advises management on what it will need to do once the hospital is a self-governing trust. It contains the immortal advice that managers should keep changing the product lines. I presume by that they mean the specialties of the hospital.
The dilemma of such hospitals has been well expressed by the director of one of the private hospitals in London, the Lister hospital. He was invited to write an article outlining what he saw as the challenges to the management of a self-governing trust. He said:
The opted out hospitals will need to make firm decisions as to which services to promote and which are uncompetitive. Some specialities may have to go. The problem of unsuccessful specialities will be a real one. For how long could one carry a loss-making speciality?
I invite my hon. Friends to notice what happened between the second last and last sentences of that paragraph. There was a reference to "unsuccessful specialities". How is an unsuccessful speciality redefined? Not as a speciality which failed to cure the patients, nor as one which was not needed by the patients, but as a loss-making specialty. The population of the catchment area of the hospital and its patients may seek the right to cast their vote on the question: what if they are the loss-making patient?

Mr. Kenneth Clarke: What does that mean?

Mr. Cook: It is not difficult for them to work out what specialties are at risk of being loss-making. We can identify them easily by running our finger down the list of specialties not provided by the present private sector. They are chronic care and long-term care with no immediate prospect of cure and involving heavy expense, for example, geriatric care, renal dialysis and chemotherapy. All are lacking from the private sector and are likely to be under pressure once the Secretary of State has created commercial pressures within the public service and the NHS.

Mr. Kenneth Clarke: The hon. Gentleman is being most courteous in giving way. I am waiting for him to come up with one coherent argument for his proposed ballots. Perhaps because of the time of morning, he has so far not produced one. The manager of the Lister hospital has nothing to do with our proposals. All hospitals will depend on these contracts for finance. There is no distinction between NHS trusts and the rest. That means that they will be financed to the extent that they attract NHS patients. When they attract patients, whether for advanced surgery or basic community care, they will recover the full costs of treatment. They will not make a profit or a loss. If they are unsuccessful it will be because they are not attracting the patients of the GPs who would otherwise refer to that unit. We spent a long time on this in Committee, in which the hon. Gentleman appeared from time to time and took some part, so he knows that that is the position. I do not see the slightest relevance of his remarks to that position.

Mr. Cook: The Secretary of State has made an interesting observation which, if he means it, will requir.t him to go back and redraft many of the notes of guidance and circulars which have been going around the district

and regional health authorities for the past six months. He has just said that hospitals will recover the full cost of treatment of patients. That is not what his Department is saying to health authorities. It is saying that they must price a contract for a number of treatments with other district health authorities, their district health authorities or GPs, and deliver the required number of treatments within the price on the contract. That is the meaning of the whole contract system. The hospitals are not guaranteed the cost. If they get it wrong they will have difficulty in making ends meet. If that is not the case, it is utterly impossible to conceive what the function of creating the new system is, because at present we offer the hospitals their costs. It is that historic basis of pricing and paying the Health Service that we understand the Secretary of State is putting behind him.
If the Secretary of State is going to tell us that the director of the Lister hospital, as a director of a private hospital, has no insights to offer us about the future of the NHS, let me share with him the comments of the management of Trent region. It is within the NHS, although it seems to have every possible intention to get out as fast as possible. It produced an extremely interesting document marked "Strictly confidential" which provides advice to the personnel managers of hospitals seeking self-governing trust status. I shall return to the document later.

Mr. Rowe: I think that the hon. Gentleman has said something that, on reflection, he would not have meant to say. He stated that the people of the Trent region are working as hard as they can to get out of the National Health Service. The whole point about the hospitals—or units—is that they will remain part of the service.

Mr. Cook: That is an opinion which the hon. Gentleman is perfectly entitled to hold, but it is strongly disputed by many Opposition Members, and I shall develop that argument during my speech. If it is argued that those self-governing trusts will remain within the National Health Service, the hon. Gentleman has so redefined the meaning of that service as to put it beyond the recognition of anything that people would have previously contemplated.
I anticipate that the Secretary of State will not say that the management of the Trent region are irrelevant to our debate. Their document opens with some assumptions about self-governing trusts:
a. in the short term there will be an initial period of stability and no immediate crisis"—
that is refreshing and reassuring, I am sure—and
b. in the medium term, there will be rationalisation and contraction of services".
That is the assumption of the management of Trent region. That brings us back to the anxieties of patients in the catchment area, to whom I referred earlier. There is now a risk that specialties may be squeezed on commercial and financial grounds, but those patients require them.
Once upon a time, we were promised safeguards against contraction and rationalisation. Working paper No. 1 on page 3 promised those safeguards. The opening paragraph of the working paper on self-governing hospitals said:
There will be safeguards to ensure that essential local services continue to be provided locally.
Those safeguards were going to be the core services.
One question that patients would want to ask themselves when considering voting in a ballot on the issue is what happened to core services. It was a pretty short list,


which did not at any stage include paediatrics or maternity services. The Nottingham Post had an entertaining quotation from a spokesperson for the Department of Health, who, when asked why maternity was not in the list of core services, replied that it was because Ministers forgot to put it in. However, it does not really matter whether paediatrics, maternity or anything else was omitted from the list, because there is not a word anywhere in the 60 clauses of the Bill about core services.
In Committee the Under-Secretary, who I suspect must be on the afternoon shift of these proceedings, advised us that he regretted that Ministers had got the name wrong. They should not have called them core services, because the use of those words encouraged us to have the wrong expectations. As it turns out, core services are no more than matters for negotiation between the district health authority and any hospital in the district that is contemplating forming a self-governing trust. There is nothing to prevent those trusts from deciding, during the negotiations, that they need a rate of return on renal dialysis or geriatrics that prices it beyond the reach of the district health authority, and nothing to stop the district health authority from deciding, during the negotiations, that the price offered is too expensive. Bang—between them, in the process of negotiation, it is gone; it is priced out.
I suggest that that is one of the key reasons why patients need a voice in whether their local hospital leaves the management of the local district health authority. They will lose the choice if a specialty goes and they may even lose the choice if the hospital retains the specialty that they need, because, as the Secretary of State fairly said in his intervention, patients will get into hospital only if there is a contract with the hospital for someone to pay for them to have speciality treatment—whether it is the district health authority or their GP.
That brings me to the last reason why patients in that catchment area should be anxious about their hospital becoming a self-governing hospital.

Mr. Nigel Spearing: How can we be certain that patient needs will be defined? The scheme has been likened to going to a garage for a particular type of car repair. Is it not the experience of us all that we require treatment in hospital for a variety of reasons that involve different techniques? How will that practical problem be addressed?

Mr. Cook: I intend to deal later with that point. However, I believe that it is a travesty to describe the White Paper and Bill as proposals for the National Health Service. They regard people's experience of the NHS, particularly of hospitals, as episodic and completely unrelated to the continuity of care that they receive. The Government's proposals therefore threaten a break in the continuity of care that is represented by the present integrated service.
I was about to remind hon. Members of the contents of paragraph 2.2 of working paper No. 1. It refers to contracts with private patients or their insurance companies, with private hospitals and employers generally. We have only reached paragraph 2.2, but already we are into private provision. Let us suppose that

a self-governing trust discovers that the mark-up for private patients is higher than the mark-up for district health authority patients. Let us also suppose that the private insurance companies with which it is supposed to negotiate says, "You will get our patients only if our patients get preference and shorter working times than NHS patients." That would be the perfectly normal reaction of private insurance companies. Would NHS patients then find that they had been disadvantaged?
The prospectuses that have been published by hospitals that are contemplating self-governing status are full of commitments to expand private practice. The nearest hospital to this Chamber that is contemplating self-governing status is St. Thomas's hospital. It has published a lengthy document which contains the following statement:
There will be an expansion of private patient services, including a range of choice of accommodation.
Where is the expansion to come from? Where is the new range of choice of accommodation to come from? During the last two years that hospital has become notorious for removing NHS beds. Its expansion and new accommodation will not be a fresh site. The expansion in the number of private patient beds and new accommodation for private patients will be at the expense of the present NHS provision and of present NHS patients, who therefore are entitled to express their views in a ballot before such a step is taken.

Mr. Tim Yeo: Would it be the policy of the Labour party, should it ever come to power, to refuse to allow any National Health Service hospital under any circumstances to take private sector patients? Does the hon. Gentleman know how much income would therefore be denied to the NHS?

Mr. Cook: It is easy to answer the hon. Gentleman's second point: at present National Health Service hospitals are not permitted to take in private patients at a profit. It is only as a result of the Government's Health and Medicines Act 1988 that it is possible for them to seek to make a profit out of private practice. It is no part of the function of a free public service that is committed to meeting need, rather than to responding to market demand, to seek to make a profit out of the sale of medical services.

Mr. Yeo: Will the hon. Gentleman give way?

Mr. Cook: The hon. Gentleman has taken me wide of the new clause. I am anxious to confine my remarks to the scope of the new clause. I want to return to the new clause.

Mr. Yeo: Yes or no?

Mr. Cook: I am terribly sorry to disappoint the hon. Gentleman, but I have to say that I responded to his point. [AN HON. MEMBER: "What about the charity out of which he has had a good living for years?"] That is a very fair point.
As I do not want the hon. Gentleman to be disadvantaged in any way, I shall try again to answer his point. He may intervene again if he wishes to do so.

Mr. Yeo: Will it be Labour policy, should that party ever come to power, to allow National Health Service hospitals to take any patients from the private sector? Will the hon. Gentleman please answer yes or no?

Mr. Cook: Our policy on that matter has been set out fully on a number of occasions. The answer to the hon. Gentleman's question is that we have no intention of legislating to prevent hospitals from taking private patients. None of our policy statements contains anything to suggest that we so propose. It is our policy, however, that no patient should be brought in on a trading basis—for profit.
Secondly—and much more important—the function of National Health Service hospitals is to treat NHS patients and to meet the needs of the people in their catchment areas. If the National Health Service were successful in meeting that objective, the private sector's market would vanish. If the hon. Gentleman ever looks at BUPA's recruitment leaflets, he will see that the organisation's one selling point is the waiting lists for NHS hospital treatment.
All of this indicates precisely why we worry about a Government so patently committed to the expansion of private provision. One does not stimulate the private sector, one does not push the demand for private medicine, by subsidising it. Tax relief for the elderly patient is at the margin. If the hon. Gentleman asks, the private sector will tell him that such relief is peripheral. The way to increase the demand for private provision is to run down the public sector to such an extent that it cannot make proper provision. That is why one is suspicious of an Administration committed to expansion of private practice. Such an Administration cannot be committed to excellence within the NHS.
I was tempted wide of my remarks just as I was about to turn to the second group who, under new clause 4, would be provided with a right of consultation—the staff of the hospitals or groups proposed for self-governing status. The main anxiety about the proposals for self-governing status is the anxiety about what they will mean for patients. Staff do have legitimate concerns. Indeed, those concerns came up during exchanges in Committee on this point. The only protection for staff is provided in clause 6. It provides protection, but only at the point of transfer to the self-governing trust. At that point, staff will transfer with the pay and conditions to which they were entitled on the previous day. Thereafter, they will be on their own. They will have no right to be included in national negotiations. A self-governing trust hires and fires its staff; it sets its own wage rates; it chooses whether or not to follow a national award. Here we are considering not just Whitley council staff. What about those people who fall within the pay review body network? A self-governing trust will not be obliged to follow a pay review body award.
What about the thousands—tens of thousands—of nurses who are still awaiting a decision following the clinical grading review? What will happen if their hospital decides to form a self-governing trust? What will be done about appeals? To whom, for that matter, would they appeal?
Not only do the staff find themselves outwith national negotiating systems, but they find that they have no absolute right to collective bargaining. A self-governing trust has no obligation to recognise even the existing health unions. [Interruption.] Iam grateful for that confirmation. A self-governing trust need not confer the right to organise in a union, although the staff transferred to it will be members of a union. There is no obligation, even on a self-governing trust, to recognise any system of

collective bargaining, whether through trade unions or for any other purpose. Both those points—the exclusion from national negotiations and the loss of the right to collective bargaining through recognised existing Health Service unions—are surely sufficient to warrant the staff being asked whether they wish the hospital or unit for which they work to make such a dramatic change.
There is an even more pressing reason why the staff should be given the option of voting on this question. They are not even to be asked whether they are willing to transfer. Clause 6 does not give the staff the option not to transfer with the self-governing trust. They are not to be allowed to say, "I am sorry, I do not want to transfer to a self-governing trust. I want to stick with my present employer and hold my present employer to my present contract of employment." Clause 6 makes it clear that that option does not exist. Subsection (5) states that the preceding subsections
are without prejudice"—
that is rather nice—
to any right of an employee to terminate his contract of employment"—
it is unfortunate that we are obliged to use the legal fiction that everyone is male, especially in the context of the Health Service, where most of the employees are women—
if a substantial change is made to his detriment in his working conditions
That does not confer any additional right on an employee, because he or she has that right whether or not it is stated in the clause. I invite my hon. Friends to mark well what comes next:
but no such right shall arise by reason only of the change in employer effected by this section.
In other words, that employee has no right to terminate his or her employment because of the transfer from the district health authority to a self-governing trust. As my hon. Friends know, were employees so determined to terminate their employment, and were they to turn up at the unemployment benefit office, they would be told that they became voluntarily unemployed and did not qualify for benefit for six months.
In Committee, Conservative Members rejected Labour amendments to give staff the right to say, "No, we wish to stick with the district health authority." All right, if it has to be a compulsory transfer and staff are not to be given the individual right to say no, surely they must be given the collective right to ballot on whether their hospital should form a self-governing trust. Conservative Members have strongly insisted over the past decade on ballots of union members for every conceivable purpose. I concede that over that period unions have got in a lot of practice in balloting. I admit that some have become quite attached to the idea of ballots, but the Government will leave those members of health unions in a strange position. They have a statutory right to elect their general secretary but they will have no ballot on a change in employment that could result in that general secretary not being able to protect them or negotiate for them with the employer to which they had been transferred.
Lest any hon. Member thinks that these anxieties are fanciful, I shall deal at some length with the document produced by Trent region called "Patients before Profits". It was essentially about the personnel function of the new hospitals that are to form the self-governing trusts. Let me share with the House some passages. This is a passage from page 6 of the document:


Suppose people in key positions manifest a lack of commitment to organisational goals, ideals and values? What about renegades, subversives and opposers of what is being attempted? There will be a nettle to be grasped in terms of recruiting, keeping and getting rid of people in key positions right through the self-governing trust.
I note that my hon. Friend the Member for Halifax (Mrs. Mahon) is here. I suspect that if my hon. Friend had been an employee on such an occasion—and she was an employee of the Health Service—she would quickly be indentified as a renegade subversive and opposer. I suspect that my hon. Friend would be rather insulted is she were not swiftly so identified.
5.30 am
Page 9 of the document contains the following statement on trade unions.
A self-governing trust will need to take decisions at an early stage as to whether it wishes to recognise any staff-side organisation for collective bargaining. It may be an appropriate tactic from the first day not to confer recognition on any organisation in order that the self-governing trust can pick the perfect time and opportunity to begin to enter into discussions for recognition of collective bargaining.
We should note the passage:
to begin to enter into discussions for recognition of collective bargaining.
On page 10 there is the suggestion that even collective bargaining may not be conceded:
A self-governing trust will have a choice. It may choose not to enter into collective bargaining arrangements. It may choose to continue to adopt the Whitley pay strategy or, alternatively, it may seek to impose pay deals. The trust will also need to have a clear view of its pay strategy and whether it chooses to move totally to individual remuneration packages.
I finally want to share with the House a passage from page 13. It says in the discussion on pay:
Where the issue is one of lack of competitiveness, buying out a staff group may not be a viable option as this would merely increase costs when the defined problem was that the costs"—
I remind my hon. Friends that "costs" means pay—
were already too high. The options here appear to be either to red circle existing work posts and offer different rates to new starters or to move into competitive tendering.
In that passage, the problem identified is that NHS staff are paid too much.
What emerges from the document is a picture of a management already manoeuvring to clear out those of independent mind and to remove the right to belong to a union that is recognised by the management. It is a management prepared to contemplate not even honouring existing pay agreements to new staff.

Mr. Max Madden: Will my hon. Friend also accept that the Bradford Health Service trust has already said that staff who do not like the terms and conditions on offer will be subject to instant dismissal without any right of redress and that all night sisters in Bradford have been told that the night sister posts are to be abolished under the trust? They have been told that they may be redeployed, but they fear that it would be to lower nursing grades. They are also fearful that in cases where such vacancies are not available, they will be made redundant.

Mr. Cook: My hon. Friend strengthens the case for new clause 4. If those are likely to be the changes that will flow from transfer to a self-governing trust, how can one in all

conscience deny those night sisters a say in whether that step is taken? Is it any wonder that they should worry in those circumstances? Is it any surprise that they want the right to be consulted on such a dramatic change in their employment?
So far, my remarks on staff have been directed mainly, but not solely, to the waged staff. There are also grounds for concern for the professional staff. There are the minority professions, by which I mean not professions that are marginal, but those that are small in number. My hon. Friend the Member for Newcastle upon Tyne, Central (Mr. Cousins) highlighted their position in a speech in Committee. There are only 900 medical physicists in Britain, and only 1,200 clinical biochemists. What are the implications, for small professions of that type, of the fragmentation of employers, possibly following different pay, different conditions and perhaps even the issue of different qualifications, because working paper No. I says:
These hospitals will be free to hire whomsoever they please.
What will happen to the regional spread of such professions? What will happen to issues such as training and co-operation among professions that are so small in numbers that to be effective they require a high degree of collaboration on new techniques? Those are all questions of legitimate concern to those professions, the members of which should also have the right to cast their votes in ballots about what should happen to their hospitals.
Then there is the much larger medical profession, where, I concede, there may be a different result in respect of pay compared with what I anticipate will be the result in terms of pay and conditions for waged workers. It is possible that the members of the medical profession may be able to exploit the new arrangements to their financial advantage. The NHS is the monopoly purchaser of medical staff. It has immense bargaining strength. I suspect that that explains why other European countries have to pay more for their doctors. For reasons that appear dubious to me, the Secretary of State proposes to throw away that bargaining strength that he has in relation to the medical profession.
In creating self-governing trusts, the Secretary of State is creating competitors with himself for the best qualified doctors, and the most likely result is that he will have to pay doctors more. The Trent document anticipates that in some respects and says:
There is a danger that they"—
self-governing trusts—
may overheat the market place and create an inflationary spiral in respect of certain groups of staff whereby each of the self-governing trusts are bidding up terms for scarce staff or are recycling a chronic staff shortage.
In other words, those self-governing trusts will find that they are bidding up the salaries of doctors.
The Secretary of State's views on the financial motivation of doctors is well known, since he gave birth to an unfortunate phrase which identifies their motivation with their wallets. It is to the credit of the medical profession that its response to the proposal of those self-governing trusts has not been to recognise them as an opportunity for personal financial gain. Doctors weighing up the pros and cons of self-governing trusts have given their impact on patient care very careful consideration.
But there are narrower professional issues with which we must be concerned and which have already dominated the votes that have occurred, on an unofficial basis, among consultants in hospitals contemplating self-governing


status. Most of those issues have been concerned with their contract. At present, consultants hold a contract with the regional health authority. In future, they will hold it with the self-governing trusts. To all intents and purposes, they will hold their contract with the unit general manager.
The past two years in hospitals throughout the country have been marked by a struggle between consultants and unit general managers in which the latter have been cast in the role of people trying not to get more work out of their consultants but to stop the consultants from treating more patients—from going over budget—and there is foreboding among consultants about a situation in which, by contract, their general managers will be able to order consultants to stop carrying out treatments that they believe the patient population requires.
The next issue of concern to consultants is their freedom to speak out. They were promised that freedom by Nye Bevan at the time of the founding of the NHS. That promise has been respected until now by every Government. Sometimes it has embarrassed Governments. It has certainly been exercised by consultants, who have had no regard to whether they were embarrassing Governments or their managements. A self-governing trust is unlikely to respect the freedom of consultants to speak openly and freely to the public whom they serve about the standard of service in their hospital, and the pressure on them to restrict that standard in the interests of the budget.

Mr. Yeo: I understand the hon. Gentleman's need to pay heed to his union paymasters, and to make a determined plea to protect the power of Health Service unions. Does he believe, however, that the Secretary of State should have centralised powers to dictate to every unit in the country—however small—the qualifications for the staff that that unit wishes to hire and the work, salary, hours, terms and conditions of every employee?

Mr. Cook: As far as I am aware, none of my hon. Friends is sponsored by the British Medical Association, or, for that matter, by the National Health Service consultants' association. I should be slightly surprised to find that we had formed that link without its being brought to my notice at some stage, as I am a member of Labour's national executive committee.

Mr. Yeo: What about NUPE and COHSE?

Mr. Cook: The hon. Gentleman does not need to tell me the names of the Health Service unions. Of course there are links between them and my party, and I make no apology for those links: they are one of the reasons for our being able to keep abreast of developments in the Health Service, despite the cloak of secrecy with which the Government have tried to veil them. I happen to believe that the work force has legitimate rights which must be legitimately expressed. As I said earlier, our main cause for concern is the effect on patient care, but we should not dismiss the feelings of staff.
The hon. Gentleman asked whether the Secretary of State should have the power of direction. He does not at present: most of the qualifications are set by recognised professional bodies. Certainly I am not in favour of leaving it to individual self-governing trusts to decide what are the appropriate professional qualifications and what is the appropriate training; the House has a duty to the public to ensure that national standards are adequate.

Mr. Doug Hoyle: I am sure that my hon. Friend would agree that professional qualifications have been developed not only by the unions but by the professional organisations, over many years. Are Conservative Members saying that what applies to accountants and lawyers should not apply to the Health Service? Surely professional qualifications are particularly important—indeed, essential—when life and death depend on them.

Mr. Cook: I have some sympathy with my hon. Friend's point, although it often strikes me as curious that we insist on professional qualifications for every profession except our own.
Consultants may be willing to forgo their right to speak out publicly, but it is a democratic right none the less. It was given to them by means of a parliamentary assurance, and they should be asked to give it up only on the basis of a democratic vote in which they are able to participate.
Consultants have other worries. What will happen to research programmes, for instance? Much of the most successful medical research is based not on actual sponsored work, but on the meticulous recording of patient notes over the years, and on investigations that, while not immediately necessary, are important to the consistency of the research programme. It is based on a case mix that is not necessarily consistent with the highest throughput or the greatest volume. All that may come under pressure from a board of directors looking for rapid turnover and high throughput. It may also conflict with the needs of medical training which requires that spread of case mix.
Those are all important considerations which give sound reasons why the medical profession may wish to have a vote on whether their unit forms a self-governing trust. I should like to think that the Secretary of State would not wish to deny consultants that ballot. That may be a rash presumption, but he has committed himself to that proposition. On page 22 of working paper No. 1, he says:
senior professional staff, especially consultants, must be involved in the management of the hospital…Any successful proposal would need to demonstrate that it carried the substantial commitment of those likely to be involved in the new management.
What better evidence could there be of that substantial commitment than a vote by the consultants on whether their hospital should form a self-governing trust?
5.45 am
I am not keen on a ballot confined to consultants. Other members of staff also form part of the same health team. Hospitals do not need just doctors and nurses to function; they also need ambulance staff, medical secretaries, porters, cooks, physiotherapists and laboratory staff.
If the Secretary of State is prepared only to recognise consultants, I am prepared to make the giant compromise and say that we will settle for a ballot on a consistent and official basis for consultants.
What worries me, and may worry other hon. Members, watching how the Secretary of State has gone about gathering in the applications for self-governing trusts, is that I know how he will go about getting that evidence of substantial commitment. He will find a few pliable consultants who sit around in committees putting their name to prospectuses to give the cover of consent for that hospital.
That approach is already causing tension. In Guy's hospital the consultants became so fed up with the fake consultation offered to them by management that they called in the Electoral Reform Society to carry out a ballot. Another hospital approached the BMA to hold a ballot because
the in-fighting is poisoning the business of care at the hospital.
The problem is that the Secretary of State is playing with rubber rules. The problem with rubber rules is that they create friction. If he really wants to demonstrate that the consultants' commitment is clear and above board, if he wants to get the self-governing trusts off to a start that all consultants can accept as fair and open, he should give all consultants a vote in a ballot.
I have addressed my mind to why patients and staff should wish a ballot. But another group is identified in my new clause as requiring consultation before a step is taken to form a self-governing trust. That other group is the relevant district health authority. At first sight, it may seem eccentric even to state that the views of the district health authority should be obtained. After all, the hospital that is forming the self-governing trust happens to belong to the district health authority. It owns the buildings and hires and pays the staff. Its buildings and staff are going. Yet a number of major hospitals within district health authorities have submitted proposals for self-governing status against the express vote of those district health authorities. I know of four. They are Newcastle, where the Freeman hospital and the mental health services unit have been nominated for self-governing status; Doncaster, where, as my hon. Friend the Member for Barnsley, West and Penistone (Mr. McKay) will know, the Doncaster Royal infirmary and the Montague hospital are seeking self-governing status; North Tyneside, where we have the particularly rich paradox that North Tyneside district health authority has come out against self-governing status, and the entire services of North Tyneside are seeking self-governing status, leaving the district health authority with nothing directly to manage; and West Lambeth district health authority has come out against self-governing status and there remains an application on the table from St. Thomas's—not just one of the largest hospitals in central London, but the hospital of West Lambeth district health authority.
I can think of no more striking example of the way in which district health authorities are being bypassed by a new line of heirarchy—running from Richmond terrace, through regional management, to district management and down to unit management—than the way in which the Secretary of State has been able to call forth up that line of management accountability proposals for self-governing status that bypass the very health authority affected by the application.
There are reasons why the district health authority should be concerned, and why it may wish to have its views recorded before the House in the way that I propose in new clause 4. This brings me back to the intervention of my hon. Friend the Member for Newham, South (Mr. Spearing). There is the fragmentation of the service. The district health authority's strength is that it brings together in one comprehensive management both the hospital and community services. In Scotland we have achieved an even greater integration because the health boards also include the primary care function.
I always thought that the way forward in England was to achieve greater integration of the health services in England, instead of which the Secretary of State has chosen to go for fragmentation. That begs a number of questions. What is the meaning of continuity of care when the hospital is managed by a self-governing trust and the community services are managed by the district health authority?
The best patient care and management results from close contact and common management between consultant and district nurse or occupational therapist. Already that relationship is stretched by the increasing pressure on community services from the fast turnover in hospital beds. As a result, patients who have not fully convalesced are being sent home, placing an extra burden on community services. Effectively, hospitals are achieving greater efficiency at the expense of greater cost to part of community services.
If this happens now, how much more will it happen once the district hospital and community services have separate budgets and separate managements? Will not the self-governing trust be tempted to externalise its costs by passing as much as possible on to the community services still managed by the district health authority? That appears to be a matter of legitimate anxiety to the district health authority, which should have the right to record its views to the House. An essential reason for that anxiety is that the Government's new structure deals with hospital treatment as an episodic, isolated event, limited in time.
The hon. Member for Pembroke (Mr. Bennett) who, unfortunately, is not with us——

Mrs. Mahon: Fortunately.

Mr. Cook: —the hon. Member for Pembroke who, fortunately, is not with us.

Mrs. Mahon: That is better.

Mr. Cook: I am glad that I carry my hon. Friend with me on that point.
The hon. Member for Pembroke, unfortunately, was with us throughout that Committee proceedings, as my hon. Friend will recall. During one of the Committee sittings, he said that organisations that claimed to represent patients were bogus because patients' experience of the Health Service was limited to two weeks at a time. That would come as a novel insight to the Asthma Society or the Epilepsy Society which, by definition, represent people who are lifelong patients. It is a revealing glimpse into the way in which the package of measures before the House is dominated by the concept of short bouts of illness, and rapid cure and turnover. That is an experience limited to only a minority of patients. For the majority of patients, the episode in hospital is part of a continuous experience in which continuity of care is marked by transfer from primary care to hospital, and from hospital back into the community service. That is an issue about which any district health authority, or health board in Scotland, might wish to express views to the House.

Mr. Spearing: I am grateful for my hon. Friend's exposition of the point that I raised earlier—the disintegration inherent in the Government's proposals. Is he aware that I understand that St. Thomas's hospital stated specifically to those whom it wished to recruit that it would be handy and near to the proposed Channel tunnel terminal at Waterloo? At the moment, the district


hospital in Newham is not contemplating opting out. However, should—by some chance—the Channel tunnel railway come to Stratford, according to the Government's proposals the hospital could opt out without any vote or any concern for the district health authority. Is not that the precise point that my hon. Friend is making?

Mr. Cook: I well remember my reference to that. I said that St. Thomas's claims that one of the advantages of opting out would be that, because of the proximity to the Channel tunnel terminal, it could attract overseas referrals. St. Thomas's will have to do some rethinking in the light of what has happened with the Channel tunnel, but the idea existed that it might receive overseas referrals—presumably treated as part of its expansion of private patients' facilities, in the new range of accommodation for private patients at the expense of NHS provision.

Mr. Rowe: It would be only a marginal extension of the practice of St. Thomas's hospital if it went across the Channel for patients. It has been trawling for patients around the Medway towns and the rest of Kent for many years, at the great expense of the Medway towns, in order to keep alive one of the many hospitals in London for which there is no longer any serious need.

Mr. Cook: Without necessarily taking a view on whether the hon. Gentleman is correct, his contention goes to the heart of my new clause. He said that St. Thomas's meets no real need in the local population. That contention would be bitterly disputed by the West Lambeth district health authority. The new clause seeks to give that authority—which is opposed to St. Thomas's seeking self-governing status—the statutory right to have its views recorded in a report to the House. It would be proper for the hon. Gentleman in those circumstances, should he choose, to vote down that report and the views of the authority. If he is to bandy around such wild statements, we should confer on the health authority the right to express its views to the House and to protect the people whom it serves, who also strongly feel that they still require those services. I expect that the hon. Gentleman will soon recall the words of the Under-Secretary in Committee—not all of my hon. Friends will be aware of them—when he said, with characteristic candour, that as a result of the operation of capital charges—which would penalise the centre-of-London hospitals—some patients from those hospitals were being redirected to peripheral areas where capital charges were less costly, possibly Mid-Kent and thereabouts.
On the issue of new clause 4, I wish to focus on the anxiety of a district health authority rather larger than West Lambeth—for example, Leicester—or a health board—for example, Lothian—that has more than one major hospital. It may well have developed those hospital services not to compete with each other as the Bill supposes, but to complement each other. I shall cite the example of Edinburgh, a place I know well. It has two major hospitals—the Western general and the royal infirmary. They have been developed so that the rarer specialties are allocated between them to provide a complementary balance, not on the basis of a competitive scramble for the patient. The health board chose and planned that strategy because it is cost effective, and cuts out competitive duplication in expensive equipment and rare and expensive skills. It avoids the waste of the

American system in which every commercial hospital has to have its own latest piece of technical gadgetry to retain an image necessary to succeed in competition.
A health authority with more than one hospital may wish to record its anxiety to the House about what would happen if one of the hospitals were to opt out. What changes would that cause in the other hospital that remained directly managed? How would it adjust to meet the competition? What new expenditure would be necessary? What new staff would it need? What new specialties might it have to consider adopting in order to meet the competition? Those are all considerations that the Minister may miss as he mulls over the questions in Richmond terrace. Those are considerations which the health authority has a right to have recorded in the House.
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There is one even greater ground for anxiety among health authorities. Let me introduce this passage by reminding the House that the hospitals and the units setting out on the self-governing path are being invited to push the boat out into the new competitive sea. On the basis of the statements that I have seen by managements who are peddling self-governing trusts, there is an intriguing feature common to all the prospectuses and statements.
Every management seeking to encourage its staff to go out into the competitive sea says that it will succeed in the competition between hospitals. Logically, they cannot all be right. Some may succeed, but competition implies that there must also be losers. A district health authority is surely entitled to express its view as it answers the question, "What will happen if our district general hospital is the loser in the new competitive environment?" What if the hospital fails? It is not a fanciful question. It is a feature of the commercial market that there is constant contraction and expansion of competing firms.
In America, where competition between hospitals is commonplace, 90 acute hospitals have closed in every year of the decade. Will the same logic apply to these hospitals? Apparently, yes. The previous Minister of State, before his rapid and unexpected departure, went on record as saying that it was no part of the new NHS to subsidise hospitals that could not compete efficiently. Translated into the local context, that means that if a district general hospital has gone into a self-governing trust and is unable to make itself financially viable, the district health authority will see it closed because it is no part of the new NHS to subsidise hospitals that cannot compete efficiently.
Is there a safety net? If not, surely the district health authority is entitled to express its view on whether it wishes to see its general hospital take that competitive risk. That is undoubtedly also of concern to the staff and to the unions of the Health Service. After all, they are very much in the boat that is being pushed out in the competitive sea. They may want to ask, "Will it sink?" That is another reason why they should have a ballot. It is certainly the consideration which should weigh uppermost with the district health authority in expressing its opinion.
Until a year ago no NHS hospital had been required to price a single contract or a course of treatment to its district health authority. It is now being invited to enter the new competitive market in which it will have to do precisely that. The original theory put forward by the Secretary of State when he launched the White Paper was that by April of next year each candidate for


self-governing status in the first wave would have cracked the problem of how to price contracts, would be able to price a contract on every treatment and could also guarantee that the aggregate of each contract balanced the total expenditure of the hospital and of the unit. I concede that there has been much hedging and settling for second best as the sheer impossibility of the task became clear, but in essence those hospitals and units contemplating self-governing status are still left with the challenge of how to negotiate contracts that result in revenue matching expenditure. How will they do that? That question will surely exercise minds in many district health authorities and the staff at the hospitals. After all, the staff have witnessed at close hand the financial skills of unit general managers over the past two to five years. They have not always been impressed by the financial acumen of those general managers. Indeed, over the past year the Secretary of State has been constantly blaming those general managers for weak local management which has resulted in the financial crisis in the health authorities. However, the Secretary of State is now putting the charge for the financial viability of hospitals on those general managers. The tools that he is providing for them are pretty rough and ready.
When the White Paper was launched a year ago it was suggested that the pricing of contracts could be achieved by adapting the computer system for the resource management initiative. That computer system has not yet been evaluated and it was developed for a purpose entirely different from costing and pricing contracts. The district health authorities and the staff representing the hospitals within the resource management initiative quickly decided that they would need more time before they could price a contract.
There are only six hospitals in the resource management initiative and five of them made it clear from the outset that they could not carry out that function in the timetable required.

Mr. McCartney: About six weeks ago I wrote to my local hospital about a patient who was seriously ill with gallstone trouble. I received a reply from the unit manager, not from the consultant. The answer was revealing and shows that that hospital is already carrying out the kind of exercise described by my hon. Friend.
The unit manager stated that although the consultant said that the patient was of the highest priority, the hospital had exceeded patient numbers for this financial year and therefore the operation could not take place. I received that letter on 12 March from Miss Waterhouse, the unit general manager for Wigan hospital on behalf of her consultant urologist.

Mr. Cook: My hon. Friend illustrates the other side of the contract. Not only will hospitals have to get the costs right, because every penny coming to the hospital will come by way of contracts, but patients will get into the hospital only if there is still room in the contract for additional patients.
I was stating that five of the six hospitals in the resource management initiative decided that they needed more time before they could price a contract before April 1991. The one exception was Arrowe Park hospital in the Wirral. It expressed polite interest in the concept and was on the first list of hospitals listed as having an interest in self-governing status. That hospital has dropped out of the

first division of that list. None of the hospitals that have experienced the resource management initiative computer system now want to opt out. All the hospitals that are seeking to opt out have no experience of that computer system.
Therefore the Secretary of State has produced a fall-back system. He has three pilot projects for a computer system known, appropriately, as HIS—hospital information systems. All those pilot projects are in deep trouble. I notice from the latest issue of Computer Weeklythat two companies that were bidding for the system have now withdrawn. Many of the firms that did not bid, such as ICL and Istel, claim that the plans were overambitious with too short time scales between tendering and supply.

Mr. Kenneth Clarke: I have been glued to my seat for some time as I have listened to the hon. Gentleman through error after error, with misstatement after misstatement, describing the new process that he is seeking to attack. Does he accept that we have now reached the positon where all hospitals—not just self-governing hospitals—will have to provide all their services under contracts, such as he is describing, not only for acute services, but for community services also? All hospitals and all community units will be working under contracts.
Does the hon. Gentleman also accept that this issue about contracts has nothing to do with his new clause, and that the pricing of those contracts, the stipulation of quality and everything else that is required, will not depend on the resource management initiative or on HIS? We have made all that absolutely clear. Therefore, before the hon. Gentleman wanders off down this latest byway, perhaps he will return to the point raised by his hon. Friend the Member for Makerfield (Mr. McCartney) who was describing a situation which has arisen under the old National Health Service—the pre-contract National Health Service. No doubt that health authority was behaving as health authorities sometimes have to behave in response to the cash limit within which all health authorities operate. I remind the hon. Gentleman that the Labour Government introduced the system of cash limits. The position that the hon. Gentleman has described has been occurring in the NHS for as long as I can remember——

Mr. McCartney: rose——

Mr. Clarke: No, I am sorry. This is an intervention. I am replying to the hon. Member for Livingston (Mr. Cook) who has kindly allowed me to intervene.
Given that the hon. Member for Livingston accepts the system of cash limits that was introduced by his own Government, how does he propose that the Wigan health authority should cope if it does not price what it is doing, if it does not have any budgeting or information systems or any matching of work with resources? What is his answer to his hon. Friend who has complained about the unreformed NHS, which he appears to defend? In the past, the hon. Gentleman has talked about activity budgeting. Will he explain what that means, as it appears to be his answer to the things that his hon. Friend mentioned?

Mr. Martin Redmond: On a point of order, Mr. Deputy Speaker. It is not fair that the Secretary of State should make such a long intervention when he will


have the opportunity of making his own comments at the Dispatch Box to try to sell what he is trying to sell. It is appalling——

Mr. Kenneth Clarke: I can reassure the hon. Gentleman that I shall make my speech as soon as I am enabled to do so after this third-rate filibuster to which the Opposition have now reduced our proceedings——

Mr. Bob Cryer: On a point of order, Mr. Deputy Speaker. Could you tell the House whether my hon. Friend the Member for Livingston (Mr. Cook) has breached any of the Standing Orders during his excellent outline of the new clause?

Mr. Deputy Speaker: I think that we had better get on with the debate. I call Mr. Cook.

Mr. Cook: Indeed, we had, Mr. Deputy Speaker. However, first I require your guidance. My hon. Friend the Member for Bradford, South (Mr. Cryer) has been good enough to point out that you have not intervened at any point to draw me to order. If, when responding to the Secretary of State, who has tempted me to discuss the general financial environment of hospitals and to respond to some of the statements that he made, I stray out of order, could you guide me, Mr. Deputy Speaker?
Since the Secretary of State has raised this point, let me respond to it. The right hon. and learned Gentleman said that cash limits were introduced by the last Labour Government, to which I can make two responses. First, I pray in aid my hon. Friend the Member for Makerfield (Mr. McCartney) and invite him—[Interruption.] I am terribly sorry if I have misplaced my hon. Friend, who is unusual among Scotsmen for having a detailed knowledge of Lancashire geography which is denied to many of his compatriots. I pray in aid my hon. Friend who has a knowledge of his area that stretches back to the days of the last Labour Government. Can he recall a like case that arose during the period of the Labour Government?
My second response to the Secretary of State is that although the last Labour Government introduced cash limits, they were subject to supplementary estimates. Throughout the period of office of that last Labour Government, the cash limits were automatically raised to reflect every staff and pay increase. It is the loss of that automatic uprating in line with the award to staff which has created the squeeze of the hospital sector under this Government.
I put it to the Secretary of State, since he asked the question, that I and my right hon. Friend the Leader of the Opposition have stated our commitments clearly. The next Labour Government will do two things in the hospital sector. First, they will restore to the hospital sector that sum by which the health authorities estimate that they have been shortchanged by this Government since 1984. Secondly, we shall fully fund pay awards that are made thereafter. I notice you shifting uneasily, Mr. Deputy Speaker. I am conscious that it is perhaps time that we returned to the new clause.
6.15 am
I wish to respond to one point in the Secretary of State's lengthy intervention—which I believe was in order. He made a comment about computer systems. I was not objecting to computer systems. It would be a good thing if more computer systems were developed within the Health Service. The point that I queried and which has been

queried by Computer Weekly and by most reputable computer companies is whether it can possibly be done in the time scale on which the Secretary of State insists. He is shoving hospitals and health authorities down a path at a pace that is likely to guarantee chaos.
Just as the staff who work in hospitals should have a vote and patients should have the right to a ballot, the district health authority should have the right to record its views before the House. I have dealt with each of those three groups separately. But it is worth recording that they all have reasons in common to worry about the self-governing proposals. Each has a right to wish to express its view before self-governing status is acquired
I stress to the House that if it does not accept new clause 4, it will leave each of the three groups with no statutory right to express a view on the proposal for self-governing status. That is because the Bill makes little provision for any consultation before, during or after the creation of self-governing trusts.
If new clause 4 is not accepted, there will he no consultation before self-governing trusts are set up. There is no proposal in the Bill for consultation. Ironically and rather eccentrically, it proposes that there should be consultation before a self-governing trust is wound up, but not before it is created. It is one of the rare flashes in the Bill that suggest that the Secretary of State may have a sense of humour.
Staff, patients and health authorities will be excluded from the choice of directors. Just as the Secretary of State will decide whether to set up the self-governing trust, he will appoint the directors. There are only two constraints on his choice. First, in appointing the non-executive directors, he must consult the chairman. Who appoints the chairman? The Secretary of State. Secondly, the two non-executive directors drawn from the local community will be appointed by the regional authority. Who appoints the regional health authority? The Secretary of State. There is a seamless web stretching back to Richmond terrace.
Staff will have no right to nomination, community health councils will have no right to consultation, and patients will have no right to representation. Most breathtaking of all, the district health authority will have no right to nomination. The Secretary of State's choice of the regional health authority as the body which nominates the local community representatives is particularly eccentric.
As the College of Health has observed,
A board of 10 directors with a Chairman appointed by the Secretary of State and including at least two community directors appointed by the regional health authority does not sound like local people running their own hospitals.
I may be wrong. Perhaps the non-executive directors will be excellent people who are so much in touch with the local community and staff that there is no need for the new clause. Possibly, the need for new clause 4 will vanish at the announcement of their names. The simplest way to put that thesis to the test is to name them. It appears that the non-executive directors have already been appointed.
I have with me the minutes of the conferences of project managers held in December, January and February, all in large central London hotels. There is something perverse about decisions on local hospitals being taken in central London hotels behind closed doors.

Mr. Madden: Probably expensive hotels too.

Mr. Cook: Certainly not cheap hotels. I concede the point to my hon. Friend.
I draw attention to paragraph 7 of the minutes of the December conference which was held in one such hotel. I cannot name which one, but most were held either in St. Ermin's or the Grosvenor. The heading reads, "Non-executive helpers" and continues:
Original chairmen have been commissioned by the Secretary of State to provide names of non-executive helpers by the end of the year.
That is the end of last year. It becomes patent that the phrase non-executive helpers is a transparent way of referring to non-executive directors whose names were provided to the Secretary of State by the end of last year.
I brush over the fact that we are still debating the Bill which creates those self-governing trusts. I overlook the fact that the Secretary of State has at present no power to appoint non-executive directors of a self-governing trust anywhere. I leave aside that constitutional nicety. I seize on the possible convenience of that to our debate.
If those non-executive helpers are the right people, perhaps we do not need the right of consultation through a ballot. This may be an opportunity for the Secretary of State to cut short the debate. Will he name these non-executive helpers whose names he received by the end of the last year, and share them with the House?

Mr. Spearing: Intervene now. Come on.

Mrs. Mahon: What about the long intervention now?

Mr. Cryer: Come on windbag, get up.

Mr. Cook: I would not wish the Secretary of State to remain so glued to his seat that he cannot intervene. His silence on this occasion speaks more eloquently than his intervention on the last occasion.
These non-executive helpers are remarkably coy. The rest of the paragraph states:
Project managers have reported that in some cases such helpers are not prepared to be named publicly, at least until a firm decision to submit an application has been made. Some argue that public identification of such a helper may not be acceptable to clinicians at this stage.
It emerges from that minute that these are not people who represent the local community; these are people who are terrified of the reaction of the local community to their names becoming public. That reticence to go public is another good reason why staff and patients should have the right to a ballot before a hospital is handed over to these coy missing names.

Mr. Kenneth Clarke: May I share with the hon. Gentleman the reason for my diffidence and that of some non-executive helpers? My guess is that they are rather loath to be drawn into the daft debate that we have had for the past hour about self-governing hospitals. The hon. Gentleman has misdescribed, deliberately in many cases and sometimes accidentally, just about every feature of the self-governing hospital proposal. I have not the first idea how he would describe the role of these individuals if they were named. No doubt he would cast them in some Mephistophelian guise. If we get outside people with business experience to help those contemplating the possibility of a self-governing trust in their locality, they should not be exposed to this sort of nonsense, even if hon Members must.

Mr. Madden: How much are these helpers being paid?

Mr. Cook: We can answer that succinctly. The Bill provides for £10 million to be paid to members of the new health authorities. [Interruption.] I think that the Secretary of State is in danger of misleading the House by saying that they will not be paid at all. Payment to the directors is a matter for the self-governing trusts to resolve.

Mr. Clarke: Given that smearing everybody's interest has been a feature of our debates from time to time, I took the intervention of the hon. Member for Bradford, West (Mr. Madden) to mean that non-executive helpers have been paid in some way for their present role. They most certainly are not.

Mr. Cook: I understand from that intervention that the Secretary of State is confirming my statement that the directors will be paid by the self-governing trusts once they are established.
I found two points in the Secretary of State's penultimate intervention particularly interesting. First, when he referred to the qualifications and background of the non-executive helpers, he named only one consideration—business experience. Not community representation, not medical qualifications but business experience. Secondly, the reason he gave for the helpers' coyness about being named was that they were not willing to enter into debate. I understand why people may not wish to enter into democratic debates and may not wish to mix with politics and I do not mind that. They are perfectly entitled to get on with their business and private lives as they wish. However, they are not entitled to seek to run major public services such as the Health Service because people who purport to run those services have to be prepared to enter into debate with Members of Parliament and with Opposition spokesmen on health.
There has been a revealing exchange between the two Front Benches about self-governing helpers and the direction in which self-governing trusts are going. The last area in which staff, patients and district health authorities are likely to find themselves excluded from having a say is in the future of the self-governing trusts. Working paper No. 1 on page 14 promises:
In general, the Government looks for as much openness as possible in the management of the NHS hospital trusts. As a minimum, each Trust should hold an annual meeting open to the public, at which a report on the previous year's performance, the accounts, and the business plan would be formally adopted"—
not by the public, but by the trust.
I put it to the Secretary of State that an annual meeting at which annual reports are adopted by the trust in front of the public is scarcely
as much openness as possible.
It is pretty mininal openness.
Three paragraphs in the working paper are headed "accountability". They are all concerned with financial accountability; none of them is about democratic accountability. As has been said, accountability of an annual meeting adopting annual reports is no more open to the public than the board of Unilever or Harrods is open to the public. Before the boardroom doors are closed and self-governing trusts are established, staff and patients must be given the right to express their views.
The last reason for staff and patients to be given a vote, under the terms of the new clause, is that there have been a number of such ballots already, on an unofficial basis.


We have debated a number of them in Committee. Wherever those ballots have been held they have come down crashingly against self-governing status.
In Aberdeen, where there was a ballot of consultants, 251 votes were cast and 80 per cent. of them were against self-governing trusts. In the Borders general hospital in Scotland in a staff ballot, 831 votes were cast and 80 per cent. were against. In towns in the north-west of the country there have been a number of ballots open to both the community and the staff. The total number of votes cast was 30,920, with 620 in favour and 30,300 against. In the east Midlands more than 7,000 people were polled in various locations. The vote for self-governing hospitals was 446 and the vote against was 6,500. In a ballot of 800 consultants in Wessex, there was a clear majority against any hospital seeking self-governing status. The pattern is unmistakable. Across Britain—from Aberdeen to Cornwall and from Blackpool to Lincoln—there is the same message. Given half a chance to take a local decision, local people do not want local hospitals to leave the management of the local health authority.

Mr. David Winnick: The real reason why the Secretary of State does not want ballots to take place is that he knows that whenever there is a ballot there is bound to be an overwhelming majority against opting out. If he thought otherwise, he would not be against ballots. The figures that my hon. Friend has given well illustrate that fact.

Mr. Cook: My hon. Friend's helpful intervention leads me to my next point.
Where ballots have taken place there may not have been a specific proposal to opt out. Where there has been a specific proposal by hospitals to opt out, we find exactly the message that my hon. Friend suggested. There is only one major hospital in Scotland that has expressed an interest in forming a self-governing trust: the Royal Scottish National hospital at Larbert.

Mrs. Wise: My hon. Friend referred to a hospital that has expressed an interest in opting out. He is falling into the trap of accepting, unconsciously and unintentionally, the definition of a hospital that is implicit in the legislation: that the hospital is not the staff, or the patients, or the local community but simply the general management. I ask my hon. Friend to make it clear that he rejects that definition of a hospital. If he uses shorthand, such as "a hospital has applied to opt out", may we take it, nevertheless, that he rejects that definition of a hospital?

Mr. Cook: I am justly rebuked by my hon. Friend. She is absolutely correct. It is a phrase that I have slipped into using because of its frequent repetition by Conservative Members. A hospital cannot express an interest; it is a building. There are some remarkable examples of that in the original list of hospitals that expressed an interest in opting out. One of those hospitals was the new district general hospital at Gravesham, which at present is a collection of fields. There were pleasant television pictures of cows grazing peacefully in a field that had expressed an interest in opting out.
It is not always the unit management that expresses an interest in opting out. In some cases, individual members of the public have expressed such an interest. Gateshead mental services unit found that it had been nominated by

an unknown member of the public for opting out. A hospital in East Grinstead found that it had been nominated by a concerned member of the public. I am happy to say that those hospitals have disappeared from the list. The original list of 178 has been reduced to fewer than half that original number. My hon. Friend is right to point out that the decision to opt out is not a corporate decision. The point of my new clause is to ensure a ballot that would result in a genuine corporate decision by those who are involved with the hospital.
The Royal Scottish National hospital was nominated by the unit general manager and by nobody else. That hospital is unusual and distinctive. It caters solely for severely mentally handicapped patients. They have made their home for decades in that hospital. I find it tasteless that the hospital for those patients, who cannot write letters to The Scotsmanand cannot join protest marches through Glasgow, should be chosen as the pilot project for Scotland. The staff were balloted; 802 members of staff were opposed to self-governing status while 34 were in favour of it.
In Leeds, East there are two major hospitals. One of the largest hospitals in Europe expressed an interest in opting out. The two community health councils conducted a postal ballot of 1 per cent. of the electorate in 10 wards of Leeds, East. They found that 76 per cent. of those balloted were opposed to opting out and that 24 per cent. were in favour. The Secretary of State has just appointed as community representative and chair of the Leeds, East district health authority the chairwoman of the Yorkshire Conservative association. I have already said that the district health authority in Doncaster opposes the formation of a self-governing trust there. As hon. Members will know, an opinion poll in Doncaster found that 71 per cent. of electors and patients oppose self-governing status, whereas only 13 per cent. support it.
In West Norfolk, where the acute services have expressed an interest in opting out, there was a ballot of consultants. Of those, 33 came out against, and seven were in favour. How that can be regarded as evidence of senior staff being committed to self-governing status I do not know, yet the proposal there is going ahead. North Middlesex is nominated for self-governing status. In Haringey, 2,000 staff of the district health authority voted, and self-governing status was opposed by 96 per cent. of those. In Plymouth, there was a ballot of consultants. Ninety were opposed to self-governing status, and six were in favour.
The West Midlands regional health authority carried out the most comprehensive exercise. In a referendum open to every elector in Redditch borough, 32,000 votes were cast. That represented a 57 per cent. turnout—quite respectable for a local election. The people there were asked whether the local Alexandra hospital should press ahead with its proposal to opt out and form a self-governing trust. Of those people casting votes, 81 per cent. were against a self-governing trust. So there was massive opposition in that important test of local opinion.
Of course, my hon. Friend the Member for Walsall, North (Mr. Winnick) is right when he says that the Government are opposed to referendum because they produce these results. My hon. Friend was not a member of the Standing Committee, where we heard objections tumbling out of a number of hon. Members. They were at pains to point out why all these results were unreliable. One of the reasons, apparently, was that the people taking


part in the exercises had got hold of the wrong leaflets, which contained misleading information. Other reasons given were that people misunderstood the proposition and that they had been misled by me and by my hon. Friend the Member for Peckham (Ms. Harman).
In a winding-up speech in Committee the Minister said that the issue was too complex to be put to a mass vote. It is quite clear how the hon. Members on Standing Committee E would have voted on the Reform Act had they been here in 1832: they would have been against it. It would have been too complex an issue for the masses to vote on; or people are too prone to being misled by Opposition spokesmen; or they might get misleading leaflets.
At every general election in which I have stood, my opponents have circulated misleading leaflets. That is in the nature of democracy. One has to trust the electorate to be able to see through misleading leaflets. I am happy to say that, in my case, that is what has happened. This is the rough and ready nature of the British electoral system.
I come now to my concluding piece of evidence. We now have—I concede to the Secretary of State that we did not have it previously—ballot evidence that cannot be subjected to many of these criticisms. I refer to the ballot that was carried out by the district health authority in West Lambeth—the first official ballot formally organised by a health authority within the Health Service. Every member of the staff of West Lambeth district health authority was balloted. The people were presented with the issues. They were given information. The leaflets cannot have been misleading, as they were produced by the health authority.
What was the result? The result of a ballot with proper information and proper leaflets, and with not a single speech from my hon. Friend the Member for Peckham or myself, was that 2,449 people were against self-governing status, whereas 550 were in favour. I note from the press that the chair of the West Lambeth district health authority has undertaken to write to the Secretary of State to draw his attention to the result. Of course, the chair of that authority has more direct and immediate access to Richmond terrace: his daughter is the Minister for Health. I understand that, after that result, he indicated that he wishes to withdraw the community services from the bid for self-governing status. The major part of the bid—the application for St. Thomas's hospital to be given self-governing status—still applies.
Given that we were promised that such applications must show staff commitment and given that a properly organised, officially conducted ballot was held which showed that staff resistance, I regard it as an affront to democracy that the authority should persist with that application. It would be an insult to Parliament if the Secretary of State were allowed by the rules to let the unit general manager to get his way and opt St. Thomas's out so that it becomes a self-governing trust without even reporting that data to Parliament. That vote makes the case for new clause 4, the case for staff to have a right to ballot and for Parliament to have a right to know the results. On that ballot, I rest my case.
I have said enough to open up the debate. In Committee in debates on NHS trusts, we repeatedly heard how good they would be. We were told that they would release

enterprise and initiative to find new cures for cancer. If the Government believe that self-governing trusts will be so good, let them put that case to the people and let them judge. I ask the Secretary of State to have faith in his case and to believe that it will not be blown apart by a misleading leaflet or a speech by me. If he really believes in local choice, he should give the local people a choice.
I give this warning: if the Government refuse to give that choice and turn down new clause 4, we will make sure that those ballots are organised for the Government. Throughout the country, we will expose not just how damaging self-governing trusts will be to the Health Service, as a public service committed to continuity of free care, but the fact that the Conservative party knows that the proposals are so deeply unpopular that it is terrified to let the people vote.

Mr. Kenneth Clarke: When we began our proceedings on the Bill, I did not imagine that we would not embark on a discussion of the proposed reforms of the English National Health Service until more than 12 hours had gone by. At last, we have the opportunity of entering a debate. I apologise to certain Members for my getting up second, but I cannot be accused of getting up too early in terms of the time spent on debating new clause 4.
I have found the process of parliamentary debate on the Bill intriguing from beginning to end. I concede that we had a reasonably civilised discussion in Standing Committee. We completed our clause-by-clause analysis of the entire Bill—the National Health Service reforms and the care in the community clauses—within a reasonably fast time, without having to have any late-night sittings or a timetable and, for much of the time, without excessive controversy—[HON. MEMBERS: "No."] That allowed us to complete that stage of the proceedings. Obviously, there was a difference between us. The hon. Member for Livingstone (Mr. Cook) would expect me not to have been overwhelmingly impressed by all his arguments. The point was underlined to me that the deph of opposition in the Labour party to many of our proposals was not quite as great as one might have thought, given the froth outside.
After a pretty easy ride in Committee, in terms of the qualitative arguments and the length of time that they took, when we have come to the Floor of the House, we have suddenly turned to a long filibuster on the first NHS clause. [HON. MEMBERS: "No."] I have made long speeches in my time when in Opposition. I do not recall making one of nearly two hours, as the hon. Member for Livingston has just done. On a new clause that in essence covered ground that we covered several times in Committee, for two hours the hon. Gentleman produced a snippet of this and a bit of that and familiar arguments which I have heard many times before. The hon. Gentleman was entitled to return to them. Mr. Speaker selected the new clause and, of course, we must debate the amendments in order. I am glad to respond to the hon. Gentleman's arguments. As I said, having failed to mount a serious challenge to our proposals in Committee, the Opposition are in danger of reducing the Report stage to a third-rate filibuster.

Mr. Battle: The Secretary of State owes it to the House and to others who are interested to make it clear that many of us were not members of the Committee and did not have


the opportunity to hear the details of the argument. Aside from the poll tax, the Bill has been the single most important issue on which we have received correspondence for the past year. It is, therefore, important that we know the details of the argument on Report.

Mr. Clarke: It is important that everyone knows the details of the argument about any parliamentary proceeding at every stage. I merely said that we had gone by the most peculiar fits and starts in our debates. The opportunity for the hon. Member for Leeds, West (Mr. Battle) to participate in a full debate on each provision in the Bill will plainly be jeopardised if the Opposition spokesman, the hon. Member for Livingston, suddenly switches from the tactics of reasonably short speeches in Committee to two-hour introductions of new clauses once the Bill is debated on the Floor of the House. I need not detain the House for anything like the length of time that the hon. Gentleman did.

Mr. Tom Clarke: Apart from the fact that I submit to the right hon. and learned Gentleman that he is giving the House a distortion of events in Committee, does not he consider that in his first speech after the Government's defeat, he might offer a little bit more modesty than he has done so far?

Mr. Clarke: I think that I should be out of order if I went back to earlier new clauses, tempted though I am. I have given my description of events. An analysis of the length of the speeches of the hon. Member for Livingston will confirm what I have said. I shall give way as often as hon. Members wish. I anticipate that, given their current chosen tactics, they will interrupt me frequently. They obviously wish to spin out the proceedings.

Mrs. Wise: rose——

Mr. Clarke: I shall give way if hon. Members insist. If it is the desire of the Opposition merely to stop serious debate proceeding, I shall concede that. Otherwise, I shall begin to address myself to some of the hon. Gentleman's remarks.
Most of the hon. Gentleman's points, as I sought to make clear in my interventions, were not remotely relevant to self-governing hospitals, although he said that they were. I shall try to sweep together a group of the hon. Gentleman's arguments—the theme to which he recurred frequently. The theme that he often uses when talking about the reforms is that we are "commercialising" the National Health Service and that in future, we shall concentrate on what is profitable, not what is loss making. He believes that that is a threat to the future of the Health Service. Most of those points relate to the contractual basis on which health services in the acute sector and the community sector will be financed when our reforms are implemented.
As I sought to make clear in an early intervention, the NHS trusts, the self-governing hospitals and the self-governing units to which the new clause relates will not be the only parts of the Health Service engaged on this contractual basis. It will be true of the directly managed units as much as of the self-governing units that they will enter into agreements with the district health authorities and with the GPs who wish to refer patients to them, either in a block or individually, to provide the services to those patients. In that agreement, they will set out the quality and quantity of service to be aspired to. They will also set

out the nature of the service, and whether it requires continuity of care and a combination of the acute and community services, or even the management of a condition, such as diabetes. That will be stipulated in the contract and will apply to every unit, whether self-governing or directly managed.
There may be later amendments when we can discuss in greater detail the nature of the contracts. I suggest to the House that the most relevant amendments will be those later on quality. It is important to bear it in mind that when people make their choice, which they are entitled to do, about how they would prefer to be treated in the National Health Service, quality is probably the most important factor that they have in mind. So the way in which those contracts stipulate quality and the way in which we decide what quality of care the district health authorities, GPs and patients should be looking for, are probably the most important features of the contract.
In any event, contracts generally will apply to all hospitals. That is not a separate feature of NHS trusts, which can be the subject of any of the ballots to which the new clause is devoted. When we deal later with contracts, we shall make it clear that there is no such thing, and there never will be such a thing, as a profit-making or loss-making contract in the NHS. So the analogies on that basis are all false.
The hon. Member for Livingston argued that self-governing hospitals should be examined because if a hospital went self-governing, that somehow posed a threat to the delivery of essential local services. He went on to call services designated services. They are not set out in the Bill in those terms because it does not require a change in legislation to put into the reforms that we are proposing the concept of designated services, a subject that we explored repeatedly in Committee, when I tried to explain the position to Opposition Members.
When an application for self-governing status is made—and it is allowed, so that there is an NHS trust—and one then discovers that the trust is providing a service, which must be provided at that locality for a particular section of patients served by a district health authority, we have repeatedly made it clear that that will not be determined by ballot. The DHA will be able to require the NHS trust to carry on delivering that service. There will be no question, despite what the hon. Member for Livingston appeared to imply, of people being denied it because it will be priced out. They will be entitled to look to the Secretary of State to require that service to continue to be provided, and the Secretary of State will settle the price if that becomes a difficulty between the trust and the DHA. Again, that is not remotely connected to the question of ballots.

Mr. Spearing: The right hon. and learned Gentleman appreciated that the debate on the new clause involves important principles, which my hon. Friend the Member for Livingston (Mr. Cook) adequately expressed. Is the Minister saying that where there is a difference of opinion—where there is a difference of interest between a district health authority and any contracting hospital, which may be a hospital of the type that we are discussing—the judgment of what is reasonable, or a similar form of judicial responsibility, will be placed on the Secretary of State? If so—and the right hon. and learned Gentleman said that it was so—is not that centralisation of the sort that his party is against in principle, as well as putting on a central authority, at the Elephant and Castle or


anywhere else, a duty to make a judgment of clinical and medical matters for which such an authority is hardly suited?

Mr. Clarke: It is true that in those cases, which I believe will be comparatively rare, where there is disagreement between, say, a district health authority and a self-governing unit about whether a service should be designated as a service that must be provided by that trust at that location for a particular group of patients, in the end the Secretary of State will have to decide.
The hon. Member for Newham, South (Mr. Spearing), who is familiar with the NHS, will realise that every time a major change in the pattern of service is proposed by a DHA that gives rise to local controversy, in the end that is determined by the Secretary of State. In practice, such matters are usually delegated by every Secretary of State—including those for whom I have worked—to the Minister of State. I take the view that I have made enough decisions about closing hospitals and major changes of service to have had my fill, so I get involved now only with the exceptional ones. A large proportion of the workload of the Minister for Health, under any Government, involves making just those judgments about proposed major changes of service, although the number of those that will arise in this conext will, I believe, be somewhat reduced.

Ms Dawn Primarolo: What criteria will the Secretary of State use to adjudicate between a purchaser and a provider in relation to the provision of a core service in a given area? I do not think that that has been dealt with, although business plans are being prepared.

Mr. Clarke: I think that that has been spelt out, so I shall give an unscripted answer. The criteria will relate to whether the district has a reasonable alternative to the service to be provided from the location of the NHS trust. What is reasonable will depend on accessibility and geography, and also on whether any service of equivalent standard is available.
The circumstances will vary. Someone with a rare heart complaint, for instance, will be unlikely to find a designated service at his local hospital: people can travel hundreds of miles for such treatment. By definition, however, a high proportion of community services will be provided locally, in particular localities and by a particular part of the Health Service, and many will be designated. It will depend on the local circumstances of each case. That is why we have not spelt out the details of maternity provision. The maternity service varies throughout the country; it is also a service in which people particularly want choice. Indeed, we all want mothers to be given choice, rather than a single place being designated for all patients from a particular location.

Ms. Primarolo: Can the Secretary of State give us his definition of "local"? The definition in Bristol, where three district health authorities converge, may be very different from the definition in Cornwall.

Mr. Clarke: I agree that that could vary from place to place, but it refers to what is reasonably accessible to the population—given the geography—and to the service or specialty involved. We are not specifying a three-mile

radius, for example, because, whatever a patient's condition, whether it is essential and reasonable that the service be provided locally varies from one area to another, as do the distances involved. The main test will be whether there is any reasonable alternative.

Mrs. Mahon: I questioned the Secretary of State closely last year about whether DHAs such as mine would keep their accident and emergency services, and he gave me a couple of answers. I asked the same questions in Committee. According to the answers, the trust or the DHA will decide what is local. Will the Secretary of State give me a guarantee that Calderdale will keep its accident and emergency service?

Mr. Clarke: I do not give such guarantees about any accident and emergency services, and never have: I have closed one or two in my time, as have my predecessors, both Labour and Conservative.
A major change in the service, such as the closure of an accident and emergency service, would be approved by the Secretary of State only if it were part of some improvement in the service: indeed, it would normally be proposed only in such circumstances. We do close accident and emergency services. I remember closing some in London, where they used to be extremely close to each other. There can be advantages in having one good centre, rather than a lot of underequipped ones scattered around a small area.
Before the hon. Lady decides that I am speculating about Calderdale, let me say that I cannot remember the configuration of accident and emergency services there, off the cuff; nor can I say whether anyone is remotely contemplating any change of any sort there. Under the new arrangements as under the old, however, the NHS would consider closing an accident and emergency unit only as part of an improvement in service.
Considerable pressure is being imposed on us by the Royal College of Surgeons to examine all our trauma services. It has made some extremely interesting propositions. Many surgeons think that it might be a good idea to concentrate more of our major accident work on fewer sites, and build up expertise and a range of specialties on those sites.
There is often a conflict between medical and public opinion. The average member of the public, including most hon. Members, probably thinks that accident and emergency departments should ideally be a couple of minutes away from wherever one happens to be knocked down. That is not something which would worry many doctors. They would want to know what was in the accident and emergency department to which someone would be taken. In particular, for a head injury, they would want to know whether there were the necessary specialists in the place to which the person was to be taken.
Those are the only sort of criteria that will go into such judgments in future, as under the old arrangements. As I have repeatedly made clear, it is nonsense to keep raising fanciful claims that an accident and emergency department would be closed because it was unprofitable or because people would go roaring off into doing private work at the expense of NHS work.
7 am
The decline in NHS work is dealt with in the Bill. It would have been nice if, in moving new clause 4, the hon. Member for Livingston had reminded himself of clause 5(6), which makes it clear that anybody engaging in private
sector work must not do so at the expense of NHS contracts into which he has entered. The idea that he put forward, en passant, wandering off into his red herrings with a particular flourish, that such people might take in private patients who could be put ahead of NHS patients in the waiting lists is complete nonsense, as the hon. Gentleman knows. We have repeatedly committed ourselves to the six principles that are accepted by both sides of the House that govern the treatment of private patients in NHS hospitals. One is that they should be treated according to clinical priority and we, like the Labour party, are against the idea of private patients queue-jumping. That will apply within the NHS within which there will be self-governing trusts in future.
The only change on private practice that the hon. Member for Livingston was proposing, as far as I could see, was that he would reduce the price charged to private hospitals. Apparently, he thinks that it is wrong that the NHS should make a profit out of private medicine. But he will not stop private hospitals engaging in private medicine on NHS premises. That is an extremely quixotic gesture. He will deprive the NHS of income by reducing the prices that it charges to the private sector. What a strange insight into the alternative policy of the Labour party on the NHS.

Mr. Simon Hughes: Is not the inevitable logic of a system, whereby the district purchases and chooses on the basis of cost between different offering hospitals that it will go for the cheapest option? As a result, there will be competitive activity between the providers, the hospitals, with, certainly in London—more obviously in London than elsewhere—the resultant forcing out of some of the services that would be regarded as core services simply because cheaper ones will be available, which districts will be obliged to contract to purchase. Is not that the inevitable consequence of a system that will become more competitive and that requires districts always to be seeking to save money, irrespective of quality, which is another criterion altogether?

Mr. Clarke: I am genuinely grateful to the hon. Gentleman because his intervention goes to the heart of a genuine controversy about our new proposals. It is simply not correct to say that districts will choose to place their services according to cost and cost alone. Many reputable critics of my proposals base their whole case on the proposition that somehow districts and GPs will feel obliged always to go for the cheapest option. I think that we all agree that there can be no more foolish approach to the obtaining of medical care than to believe that the cheapest option is always the one we should go for. Not one hon. Member would remotely want our health care to be decided on that basis. However, I would also guard everybody against the simple assumption that is often made, not least by hon. Members, that the most expensive is necessarily the best. That underlies many of the arguments that I face. The range of costs in the Health Service, under the present system, varies amazingly between one district and another. It by no means follows that the districts with the most expensive services are the best.
In making all those decisions, people will make a judgment, based on the combination of quality and the use of resources, as they should be doing now. All health

judgments tend to be like that. Most people engaged in health care, be they professionals, clinicians or managers, constantly have to make difficult judgments on what is the best quality of care that they can obtain or provide for their patients within the resources available. Under the new system, that process will be undertaken in a more rational and open fashion, and people will see to what type of care and what quality the resources are being committed.

Mr. Hughes: I am grateful and I understand that. Let us take a specific example. My local health authority of Lewisham and North Southwark has options. It might go for what it regards as perfectly good orthopaedic treatment, to, for example, Guy's, King's College, or Maidstone hospitals. The qualitative judgment will be similar. Therefore, it will be bound to make its decision on the basis of the financial judgment. It will have many other needs to meet, and if it is looking to provide all those other needs for the populace of Lewisham and North Southwark, it will inevitably choose—if there is not much to choose on quality—the cheaper option. Eventually, that process will drive out alternatives because the market will have taken over from a National Health Service providing corporate care.

Mr. Clarke: If there is not much to choose from on quality that might happen. The first judgment that the authority makes will be based on quality, as I have said. However, in using all the resources, it will have to do what it does now—to make decisions about how to get a comprehensive service so that everything, not just orthopaedics, is financed. It will want to get the best quality across the spectrum, using the resources that it has.
It may be that in some areas the de luxe quality is so expensive that the authority will decide that it cannot spend that much on orthopaedics and has to go for a cheaper option, either because it has to get the volume to get its waiting lists down or because it wants to invest more money in its mental illness or mental handicap sectors.
Those sound difficult choices, and they are. But they are exactly those that the Health Service has always made. The odd-sounding events described by the hon. Member for Makerfield (Mr. McCartney) related to a specific example, about which I know nothing. However, we all know the sort of difficulties that health authorities currently get into when they have to make just such judgments.
The trouble is that, at present, authorities do not know exactly how much they are spending on their orthopaedics or their community services. Nobody measures the quality. We are introducing quality control through clinical audit. The authorities do not know whether the services that they are receiving are better than those at the place down the road. When a district discovers that it is spending spectacularly more on a part of the service than is the next-door district health authority, it is often a revelation to those in the district. When they look to see what they are getting for the extra money, they may find that it is nothing, in which case the contract system will enable them to rationalise.

Mr. Hughes: I do not object to auditing and ensuring that money is spent wisely. However, the Secretary of State must appreciate that the difference between the system that he proposes and the present system is that, at present, the same patients in the same health authority, for example, Lewisham and North Southwark, look to their local


hospital to provide all those services. The difference will be that when the quality judgments work out equally and the cost judgments are different, instead of all the services being available locally, some of them will no longer be available locally. People will be sent away for those services because the district will have no other choice, so gradually there will be a contraction of the wide range of local health services provided in the local community by the local hospital. Gradually, that will whittle away choice, as people will not have the choice to go to their local hospital for the range of services because they will not be there any more.

Mr. Clarke: We shall not agree on that and we are in danger of repeating ourselves. Lewisham and North Southwark will want to respond to the local population, who may want to be treated locally. I accept that in most urban areas the population want to have the bulk of their medical care from the nearest hospital, where their relatives can easily visit them. They sometimes find that the planners, who are defended vigorously by opponents of my reforms, are closing down the little local hospitals.
The districts will be under a duty to respond to the wishes of their general practitioners who, under our new contract, will be driven by their patients' wishes. The districts will put in place a series of contracts to provide local services. They might find that their local services are spectacularly more expensive than the alternative, but they could still continue to place their contracts locally——

Mr. Hughes: They do.

Mr. Clarke: They may be doing that at the moment, but the costs are inordinately high. When they discover that—and I do not know whether Lewisham and North Southwark ever will—they have to ask themselves whether that is consumer friendly and whether the fact that it is local is sufficient reason to justify the increase in costs. They will put great pressure on the local hospitals because all the money will go in high costs, which will inhibit their ability to develop their services.

Ms. Harriet Harman: Does the Minister realise that the reason why costs will be spectacularly high in London will not be luxury or quality, but capital charges which, for the first time, will have to be paid by NHS and opted-out hospitals? Therefore, the cost of treatment in Maidstone or Brighton will be very much cheaper. For certain surgery and for ordinary district general hospital services, patients from London will be bussed out to outlying hospitals where the land charges are much cheaper. Given that local accessibility is a key factor in quality, does not that mean that there will be an undermining of the quality of those services for people in London.

Mr. Clarke: Health care in London is high-cost health care, and always has been. Capital costs are a key feature of health care costs in London. That will be exposed by our capital charging system, and why not? We must face up to that truth. The Government did not invent the position. The fact is that it costs more to treat people in hospitals in London. That is why a permanent problem for about the past 120 years in the British health care system has been the concentration of so much of our hi-tech teaching

health care system on practically the most expensive site in Europe—all in the middle of London and within a stone's throw of each other.
We are doing nothing other than what should be done in any sensible, businesslike organisation—exposing where the costs lie, including the capital costs in London. If the Labour party does not want to face up to those costs in a system that it aspires to run, it is simply burying its head in the sand.
Of course, there is the danger of a sudden exodus if the Labour party did nothing about the problem. However, I do not think that it would be patients in Lewisham, Peckham or Lambeth who would stop having their treatment in London. They would say to their GPs and the DHAs, "We want to go to the local hospitals. In fact, we want more access to them. There is too much fancy stuff coming in from outside."
The inhabitants of Hertfordshire, Kent, Bedfordshire and Essex may well ask their DHAs, "Why are we having to wait such a long time to go to those expensive hospitals in London when, with the same money, you could treat us a great deal quicker in the place where we want to be treated, which is the district general hospital?" We must face that reality. I know that two Kentish hon. Friends here will want to make that point, and if any of my hon. Friends from Hertfordshire were here, they would also be getting steamed up about that. We must ensure that there is not a sudden cutting off and a disruption of the service.
That is why, in the new system of allocating moneys to the regions, we have built in for all time—until somebody changes it—a system of added allocations; we are still building in 3 per cent. extra for the Thames regions to reflect the inescapable extra costs of providing services in London. There are other in-built advantages in the way in which the money is distributed.
7.15 am
In the new contracting system we shall also distribute to the districts that use London services a bigger allocation of money, because we realise that we have to compensate them for the costs of seeking to place so much of their service in London. All those things have to be addressed and they will be sorted out. We are taking steps to avoid dramatic consequences and the sudden threat to the London hospitals and their standards described by the hon. Member for Peckham (Ms. Harman).
Of course, the London hospitals are very strongly placed because they include some of our finest hospitals. They cannot compete on costs. If it is a battle between Bart's and a hospital in Maidstone or in the middle of Kent, Bart's cannot get down to the costs of Maidstone. What Bart's has to offer is a world standard of excellence in the best of its services, although we should not assume that they are all marvellous. The patients and those who act on their behalf—districts, GPs and so on—will make the judgments about quality, cost and best use of resources that I described as part of the contract system.
The dominant competition will be in quality. The Opposition are so fearful of the word "competition" that the idea of different clinical units aspiring to demonstrate that they treat their patients better than others is inimical to them. They prefer a planned system, which does not allow such nasty comparisons to be made and in which people do not vie with each other on the excellence of the service that they can offer to patients.

Mr. Rowe: rose——

Mr. Clarke: I am relying on the Opposition rather than my hon. Friends to induce me into filibustering.

Mr. Rowe: I am not asking my right hon. and learned Friend to filibuster, but the fact is that the Opposition resist the proposition that there is any form of competition in the National Health Service at the moment. That is a total myth. Anyone with any idea of the bitterness and arguments between health authorities about the allocation of resources knows well that competition is alive. Furthermore, many of the London-based Opposition Members seem to believe that Londoners are incapable of travelling for treatment while people from Kent are expected to do so.

Mr. Clarke: I agree with my hon. Friend on both points, which he made passionately. The descriptions by the hon. Member for Livingston of contracts for self-governing hospitals were for the most part mere fiction. My hon. Friend has intervened to show that his descriptions of the present service were pretty rum too.
There has been reference to the professional standards required in the National Health Service. It is not the case that self-governing trusts will be allowed to set their own qualifications and professional standards—a serious point made by the hon. Member for Livingston. He did not attend all the proceedings in Committee—[Interruption.] I did not either, but the hon. Gentleman may not have reached schedule 6(2), which provides, in relation to NHS trusts, that the Secretary of State shall stipulate what the professional qualifications will be of people in the National Health Service. The trusts will not be allowed to set their own professional criteria for staff. They will be obliged to go by NHS standards.

Mr. Cryer: The Minister used the word "battle" when referring to competition between hospitals. Can he tell us what will happen to the hospitals that lose the battle?

Mr. Clarke: The word "competition" is used frequently—perjoratively on one side and in praise on the other. In the Health Service it is used in terms of quality. There will be competition to attract patients into a unit. Under our arrangements, for the first time, as long as patients continue to be referred to the unit and are treated, the resources that that unit requires will come with the patients and allow that unit to be financed. If the unit is ambitious, the people working there will want to demonstrate the excellence of their work and try to get more patients and more resources.
Under the new arrangements if a unit is not doing so well, obviously patients who used to be referred there are now being referred to another unit—the district health authority, the GPs and the patients obviously prefer to go to the other unit. The DHAs are under instructions to follow the wishes of GPs. The GPs will retain the freedom to refer their patients wherever they want and they will respond to their patients and to the new contracts that were fought so bitterly by the Opposition and some sections of the medical profession. Those contracts will make GPs more responsive to their patients than ever before.
There have always been closures in the Health Service. One of the qualities of the National Health Service is that under both Labour and Conservative Governments, the NHS has closed its redundant facilities and has developed

better and newer facilities elsewhere. There are health systems abroad that are so arthritic that they cannot do that.
We have a careful process of consultation, including the approval of the Secretary of State. My Labour predecessors closed redundant hospitals at about the brisk pace that Conservatives close them. I believe that David Ennals was somewhat quicker in that respect than we have been.
Much of the controversy now, as hon. Members will realise, is based on great arguments about planning, the policy of the DHAs and resources. Many hon. Members challenge those issues like mad because they are all open to argument.
Under the proposal in the new clause, a unit might get into difficulties. Perhaps the service is being rationalised and the unit should go. That might happen because the GPs and DHAs prefer to use another part of the system. If another part of the system achieves better quality, that is one of the better reasons for contemplating a change in the pattern of services. Of course, I hope that the less successful sections will be provoked by competition into asking why they are losing referrals. They might then use the system of clinical audit to raise their standards, and to recapture referrals.

Mr. Tim Devlin: Will all hospitals be on an equal footing or will we have the old long-standing distinction between so-called teaching hospitals that are predominantly concentrated in London and non-teaching hospitals elsewhere? All patients seem to want to be referred to teaching hospitals, even if their local hospital is just as good.

Mr. Clarke: My hon. Friend's constituency is further north than mine, but I am about as provincial as most people in the House. I cannot forbear adding Nottingham, Leicester and Sheffield to Leeds.
There is a problem with the teaching hospitals, We must ensure that the contract system does not damage the provision of undergraduate medical training, postgraduate training for doctors and continuous education for consultants. We must also ensure that the system does not damage research. That is why extensive discussions are continuing with the various interests to ensure that in attracting contracts for their services, the teaching hospitals are not put at a disadvantage because they have to carry extra costs on the contracts for teaching and research.
However, I also share the concern expressed by my hon. Friend the Member for Stockton, South (Mr. Devlin) that we must ensure that, in meeting their legitimate expectations to have education and research protected, the teaching hospitals are not placed at an unfair advantage. I do not want money put into the teaching hospitals under the excuse of protecting postgraduate education and research if that enables those hospitals, together with the cachet surrounding their names, to continue to attract patients who could perfectly well be treated in a good district general hospital close to their homes.
I actually heard the hon. Member for—I cannot remember the name of his constituency——

Mr. Cryer: Bradford, South.

Mr. Clarke: That is safer than it used to be. I heard the hon. Member for Bradford, South (Mr. Cryer) muttering,


"Level playing field" under his breath earlier. That is a good Tory slogan that has even got to Bradford, South. We are seeking to ensure a level playing field between the teaching hospitals and the rest.

Ms. Harman: Will the Secretary of State face up to the fact that the bogus link in his argument and the reason why competition will be that of cost and not of quality, as he has asserted, is that the decision about where patients will go for treatment will not be made, as now, by the general practitioner, but under the NHS contract system? The decision will be made by the managers of the district health authority, who are not trained or recruited to know anything about quality and outcome, but who are trained and recruited to know everything about cost.

Mr. Clarke: I totally refute that and I shall seek to persuade the hon. Lady that that is not an accurate description of the contract system when we reach that new clause and when the contract system is more relevant to the debate.
The DHAs will place the contracts. It will not only be the managers who decide that. The DHAs will place the bulk of the contracts, first according to the advice from their own public health adviser and other medical advice. Following our instruction that they should put in place contracts for the preferred referral patterns of their own GPs, unless there are compelling reasons to the contrary, the managers will not simply place the contracts where the DHA wants, but will place them as the GPs want. We have also made it clear that there must be a contingency fund so that any GP who wishes to refer an individual patient to a particular place outside the DHA's block of contracts will remain free to do so.
Under those arrangements, the DHAs will be much more responsive to GPs. I am sure that my reforms are building up the role and influence of general practitioners in the NHS like never before. When we ask the DHAs to take on this task, we are discovering that they are having to get to know their GPs for the first time. Many DHAs do not know their GPs—[Interruption.] They do not. It is no good laughing. This is the system that the hon. Member for Halifax (Mrs. Mahon) is defending. When I reveal some of the things that the NHS has done, the hon. Lady is dying in the last ditch to try to keep it that way.
For the first time, the DHAs, which currently manage our hospitals, are having to discover the referral patterns of their local GPs; why they refer in that way and what they are seeking for their patients in those services. That is what they will have to reflect in the contracts. That has not happened before.
General practice budget holders will be able to bypass the DHA and directly handle large sums of money that they can invest in the local Health Service, where it matters——

Mr. Allan Roge: rose——

Mr. Clarke: Well, I am not sure on what parliamentary day I shall now be able to answer the hon. Gentleman's written question. A lot of nonsense is talked about the opposition of doctors and, as soon as we proceed and I am able to answer that question, I shall reveal to the hon. Gentleman that the vast majority of GPs who are eligible to be fund holders and to have a practice budget have

expressed an interest in doing so, because GPs see what I see—that they will have a much more influential role in placing contracts than British general practitioners have ever had before—[Interruption.] No, I hate to have to tell the hon. Member for Peckham that the figures will prove that doctors are not taking seriously any of the nonsense that is being put out by her, or parts of the BMA, about the practice budget scheme. They are on the wrong side of the argument. They should have thought of it first.

Ms. Harman: Does the Secretary of State accept that GPs are putting themselves forward to become fund-holding practices because they fear the straitjacket of their loss of clinical freedom to refer under the NHS contract system? Their applications are not a vote of confidence in fund-holding status but a vote of fear about remaining in the system when the NHS contract system bites.

Mr. Clarke: That was a good try. The hon. Lady has been telling us for the past 12 months that fund-holding practice budgets are the greatest threat to general practice. So has the BMA. The hon. Lady was led into error by people who should have known better and who, in my opinion, should have invented practice budgets. The BMA has pumped its message out through the medical profession for as long as I can remember. The moment that we put out our explanation and a form and asked those who were interested to come forward, the majority applied—as I have said for ages that they would. We all meet GPs. I was in no doubt that the majority would apply. The vast majority have applied and not for the reasons given by the hon. Lady.
I wish to move on. We shall have contracts and GP practice budgets only if we can get on with the Bill. I have tried to explain why none of what took up most of the speech of the hon. Member for Livingston had anything to do with self-governing hospitals and ballots. When we got on to what had something to do with NHS trust status we reached a point about pay and conditions, trade unionism and so on when the hon. Gentleman became lyrical. Pay and conditions represent a high proportion of what is getting up the Labour party's nose about self-governing hospitals. Labour Members are desperately anxious to maintain national bargaining for pay and terms and conditions for all staff. They are anxious to retain the present strange and archaic methods of collective bargaining in the NHS. They are completely in the pockets of NUPE, COHSE, NALGO and GMBATU, the TGWU and all the people who have run fancy polls up and down the country.
I know that there is a fairly reputable and legitimate case to be made in favour of collective bargaining, national bargaining and so on. But I must correct some of the coloured phrases used by the hon. Member for Livingston to describe what faces people. NHS trusts will indeed be free to set their own pay, terms and conditions, if they wish. But they will have to negotiate them. They will not wish to do it on a dramatic scale, certainly in the early stages, not least because they will have to fit in with the contracting system of the directly managed hospitals.
Staff will transfer into an NHS trust with their current contracts of employment. Any changes would have to be negotiated and, presumably, discussed and made attractive to the staff. The clause that was objected to—the


hon. Gentleman said that people would be fired if they did not like the change—merely means that staff will not be entitled to walk out on their job simply because the hospital or unit has become a trust. They will not be able to rely on that as the basis for a claim for wrongful dismissal. The change of employer alone would not be regarded as a change to their detriment. Staff will carry all their rights under their contract, including their right to redundancy and so on. If they are treated in some of the ways that the hon. Gentleman described, they can bring a claim for wrongful dismissal under their contract.

Ms. Harman: The Secretary of State said that people will transfer from the National Health Service to the NHS hospital trusts and that they will not lose their employment rights. Staff may take with them the piece of paper called their contract of employment, but it was made clear in Committee that they will not take with them their right to have their union recognised. When they become the employee of an NHS trust, although they will have their piece of paper called a contract of employment, they will not have the right to have their union protect them when that NHS self-governing trust tries to renegotiate individually the terms and conditions in the contract. If the Secretary of State says that existing trade union members will take with them the right to have their union recognised we will accept that there is no detriment. But if they are to be stripped of that right, he must accept that there is a severe detriment on transfer from the NHS to self-governing trust status.

Mr. Clarke: The hon. Lady knows that I will not give guaranteed rights of recognition. Every employer will have to consider what trade unions are recognised. It would be foolish to say that all the unions recognised for every category of staff should be recognised in every self-governing hospital, not least because some unions will undoubtedly not have any members in those hospitals.
This is not the time for me to launch into the Whitley council procedure, although it is relevant because NHS trusts will no longer be bound by its terms and conditions. The distribution of voting rights on Whitley councils bears no relation to the membership of the trade unions. At times it is even laughable. I am not complaining. I am extremely pleased about the satisfactory outcome to all sides of the ambulance dispute, resolved finally by the staff side voting yesterday. My guess about the ambulance officers—they will never tell the Secretary of State—is that the vast majority are represented by NALGO. When I deal with the unions my belief is that it must have the majority of ambulance officers. They are outvoted on the Whitley council by the other trade unions.
At the start of the dispute the ambulance men's Whitley council consisted of NUPE, which I am sure has more members than any other union, with COHSE, the TGWU, GMBATU and NALGO. The distribution of the voting rights is quaint. I am not making an issue of this and I will withdraw it if I am proved wrong, but although GMBATU does not have many ambulance men, it has quite a lot of votes. What would be appropriate as a trade union for particular groups of staff at a particular place is different from those that have recognition now.

Ms. Harman: Even for individual employees?

Mr. Clarke: Does that mean that if a particular group of staff has one member of a union recognised nationally that member is entitled to say that his union must be recognised the monent they achieve self-governing status?

Several Hon. Members: rose——

Mr. Clarke: I realise that the moment I get into trade union rights and recognition I am likely to rouse Labour Members. I shall try to calm them down by saying again that it is fanciful to suppose that this will give rise to huge disputes in most NHS trusts, although it will give rise to a great deal of campaigning in the proposed ballots.

Mr. Hinchliffe: May I take the Secretary of State back to my hon. Friend's point about the possible clear-out of dissident staff in health authorities that opt out and propose the formation of a trust? Is it not a fact that that clear-out is already taking place? He is aware of the sacking of the treasurer of Wakefield district health authority in questionable circumstances. He stood up and opposed the expenditure of large sums of public money on wining and dining in connection with the opting-out process—he has been backed by consultants in the authority—at a time when nurse staffing levels in the wards are dangerously low. Has not the clear-out already begun? Is that not what happened to Mr. Corner in Wakefield? It will happen elsewhere.

Mr. Clarke: The hon. Member for Livingston spoke for two hours and promptly vanished. He has not been here for the past three quarters of an hour.

Ms. Harman: rose——

Mr. Clarke: There may be some good reason for that which I shall hear in a minute. The hon. Gentleman made extensive use of the Trent regional health authority document which I have never seen. There is no way in which anybody can be dismissed from the NHS without having all the usual rights of a contract of employment, unless he is in breach of it. The document has not been drafted by me or anyone in my Department so far as I am aware. I have heard only the partial quotations from it in Committee and again today. One cannot sack anybody for dissent, without having a claim against one for unlawful dismissal. One must be able to demonstrate that the person has turned that dissidence into a refusal to obey proper instructions.
I am. not going to get drawn into the management disputes in Wakefield district health authority. It is an area which produces lively disputes about management. The district health authority's case is that the treasurer in question was dismissed for failing to obey a reasonable instruction. I understand that that is now being argued about and will no doubt be sorted out in the normal way.
In my reforms I am in favour of devolving the maximum amount of responsibility at local level, and arguments between the district health authority in Wakefield and the district treasurer should be sorted out locally in the usual way. The treasurer has the usual forms of redress if he does not think that he was dismissed on satisfactory grounds.

Ms. Harman: The Secretary of State made a comment about the absence of my hon. Friend the Member for Livingston. My hon. Friend is explaining to the country at large, through radio and television, our profound opposition to the Bill and our concern about the way that


the Government refused last night to accept the will of the House to protect elderly people from eviction from private homes. Many members of the public in Conservative Members' constituencies are bewildered about the reasons why some of their constituents face eviction.

Mr. Clarke: What a ridiculous parliamentary performance. The hon. Member for Livingston gave us an easy time in Committee—both in terms of the quality and length of his arguments. As soon as we begin to discuss the Health Service on the Floor of the House he speaks for more than two hours—he was deliberately filibustering. Then he does not wait to hear a word of the reply but goes dashing off to appear on television, having apparently lost all interest in parliamentary proceedings for the time being. The hon. Member for Peckham is pointing to the clock. I should sit down soon, and perhaps you will make me, Mr. Speaker, but it is obvious that the Opposition are determined to interrupt me frequently. I have taken part in filibusters before. The moment that we get to the subject of the NHS in England, the Opposition abandon any serious discussion. They did not discuss it much in Committee, and now they are just spinning it out. They can feel free to intervene on my speech to spin it out, but I regard this as an abuse of Parliament. The idea that the hon. Member for Livingston is out there appearing on television now, boasting about his pathetic performance——

Several Hon. Members: On a point of order, Mr. Speaker.

Mr. Speaker: Order, I shall call Alice Mahon first.

Mrs. Mahon: On a point of order, Mr. Speaker. It is a matter of public record that the Opposition fought this Bill every inch of the way. I served on the Committee and I did not miss a sitting apart from an hour and a half on one occasion, which was unavoidable.
It is on record——

Mr. Speaker: Order. I am sure that that is true, but it is not a matter of order for me.

Mr. Madden: On a point of order, Mr. Speaker. You will confirm that we have now been debating the Bill for about 15 hours and that a number of Opposition Members, including myself, have not intervened although, unlike most Conservative Members, we have been present for those 15 hours. You can also confirm, Mr. Speaker, that the only contributions on the new clause, on which I have been waiting to speak for 15 hours, have been those by my hon. Friend the Member for Livingston (Mr. Cook) and by the Secretary of State. Will you also confirm, Mr. Speaker——

Mr. Speaker: Order. Yes, I can confirm that easily because I have a note of the timings. The hon. Member for Livingston (Mr. Cook) spoke for nearly two hours and the Secretary of State has spoken for an hour. We should move on to the Back-Benchers.

Mr. Clarke: Further to that point of order, Mr. Speaker. I assure the hon. Member for Bradford, West (Mr. Madden) that, unlike the hon. Member for Livingston, I will stay to listen to his speech, if he is lucky

enough to catch your eye. Secondly, I shall stop giving way to interventions, which are lengthening my speech and I shall conclude——

Mr. Madden: rose——

Mr. Clarke: I shall give way one last time—to the hon. Gentleman and then I shall conclude my speech as rapidly as I can.

Mr. Madden: On a point of order, Mr. Speaker. The Secretary of State has alleged on several occasions that Labour Members are filibustering. I would like you to confirm that you and your Deputies, throughout the 15 hours that we have been debating the Bill, have not found any hon. Member out of order. If any Member was committing a fillibuster, you and your Deputies would have called him to order. As that has not happened, the Secretary of State is clearly wrong in his assertions.

Mr. Speaker: It is within my knowledge that no occupant of the Chair has ruled any hon. Member out of order for filibustering. However, the Front-Bench speakers have made long speeches. The House will wish to hear the speeches of Back Benchers.

Mr. Tom Clarke: rose——

Mr. Kenneth Clarke: I shall give way for the last time.

Mr. Tom Clarke: I am grateful to the Secretary of State. Will he reflect on two points? First, his Cabinet colleagues who hope to get other Bills through the House this Session may not thank him for his absurd account of the Committee proceedings. Secondly, it is not unreasonable, especially after last night, that the British people should hear what the Secretary of State for Health in the forthcoming Labour Government wants to say.

Mr. Kenneth Clarke: I hear what the hon. Gentleman says. The Secretary of State for Health in the forthcoming Labour Government, if there is one, will have to demonstrate rather better knowledge of the NHS reforms after they are implemented than he demonstrated in his speech.
The hon. Member for Livingston implied throughout his speech that self-governing hospitals have something to do with the acute sector only. That is complete nonsense. Many applications have been from a combination of hospital and community services; quite a lot of them have been from community services alone. That part of the hon. Gentleman's speech was irrelevant.
The hon. Gentleman said that our reform is based on an episodic approach to patients rather than on continuity of care. I forebore to ask him what on earth his evidence was for making such a claim. He frequently makes that claim. However, as the contract system shows, and as we develop the specimen contract, it will be obvious that we are not dealing with each patient incident as though it was isolated.
I must refer finally to what purports to be the point of new clause 4: everything being handed over to ballots of staff and electors and the views of district health authorities. I do not believe that management changes of the type that we are discussing, imperfectly understood as they are, even by the hon. Member for Livingston, can be turned over to local referendums for a final decision. When the National Health Service was created in 1948 it was not


subjected to a ballot of staff and local electors. When a hospital is closed we do not ballot the staff and the electors. No major change in the pattern of services has ever been subjected to any process that is remotely like that, either by a Labour Government or a Conservative Government, during the past 40 years.
The staff will remain National Health Service employees. The hospitals will remain NHS hospitals. A previous Labour Government changed the employment conditions of private enterprise employees when private sector companies were turned into nationalised industries. I do not recall that the Labour Government canvassed the idea that the judgment on whether to nationalise an industry should be left to a staff ballot, or to a ballot of the local population, or anyone else. These management changes are akin to the 1972 changes. Nobody said that they should be subjected to a ballot. The Labour party and the trade unions are enjoying themselves. They are conducting opinion polls throughout the country and they are trying to give legitimacy to that course of action.
I give an undertaking to the House for the umpteenth time that when we receive formal applications for NHS trust status we shall submit them to the fullest process of public consultation. They will have to include business plans, plans for the development of patient services and the names of those who are proposed as directors or chairman of the NHS trust. Then there will be consultations on the basis of reasonable information. Those consultations will be taken into account in the way that Ministers of all Governments are used to doing, after which the Secretary of State will make his decision on whether to allow a particular unit to attain NHS trust status.
I have made it clear that I shall go in for the fullest consultation and, in the light of that consultation, shall base my final decision in each case on one key criterion above all others: is this application for NHS trust status in the interests of the National Health Service, of the people who work for it, and of the patients who will be served by the unit in question? I repeat that that key judgment will be made after the fullest process of consultation.
As I have said, the Opposition are trying to give legitimacy to these ballots all over the place which were discussed interminably in Committee. I do not propose to base any decisions on such straw polls. The Labour party and the trade unions are organising these on their own terms; they are using their own propaganda, and people do not have any actual proposition before them. I have a look at opinion polls occasionally. Not all of them get published. Let me give the Opposition a word of warning lest they put too much faith in all these remarkable opinion polls. One whose results I have seen shows clearly that, on the basis of almost any kind of polling, one can get different answers depending on what questions one asks. We all know that. It is why so many polls are producing damned silly answers to damned silly questions.
The response that one gets from the public about whether they approve of NHS trusts depends crucially upon whether they are told that the NHS trusts will remain in the Health Service. Some of our critics have had great mileage out of the totally false claim that these trusts will opt out of the service. The public do nor want hospitals to leave the National Health Service; nor do I. It is a deeply unpopular proposition. I have seen results that show that if the questions that are asked make it clear that NHS trusts will remain part of the Health Service a majority of

the public in most localities think that local management is a good thing. When the NHS trusts are in place—at the moment there are 79 in the first wave—people will see from experience that they will provide the much better National Health Service that we are seeking to create.

Mr. Simon Hughes: I had better start where the Secretary of State left off. He referred to private polls whose results, he says, indicate that the public really believe that the NHS trusts are acceptable. It would be helpful if those results were published. If I may give the Secretary of State a little advice, it is that, so far, there is, I believe, grave suspicion of the Government's scheme. That view is based on an objective examination of the situation.
The starting perception seemed to be that hospitals would be separated from their local health districts—that they would be on their way out of the Health Service. I know, and the Secretary of State will know, that many people have been at pains to make it clear that that is not the case. Certainly people can make mischief by pretending that the local hospital will opt out of the Health Service.
If there is evidence that proper, objective polling has indicated that people are happy that self-governing trust hospitals should be set up, that evidence ought to be produced. I have here a large, colourful document I am sorry that I do not have a smaller copy, but, after all, it is breakfast time. The document reproduces this question:
Under the Government's proposals for the NHS would you be in favour of Guy's, Lewisham and the mental illness service seeking to become a self-governing trust?
That question is reasonable; it is not loaded, as I hope the Secretary of State will agree. He can see the figure: 90·5 per cent. said no. This was a staff-side exercise. It is the first known ballot of Health Service employees in Lewisham and North Southwark. The Minister knows, too, of the narrow decision by the district health authority that there should be a ballot of all its employees. That ballot will take place. We expect the result within the next month. In Lewisham and North Southwark we have had three ballots so far. It was agreed that when the proposals have been worked out finally, the 220-plus consultants will be balloted. When there is a ratio of more than 9:1 against the Government's proposals in that reasonably put question, the staff must start by feeling some suspicion. I have referred to the view of people who work in the Health Service. The Government have cause for concern.
Although I did not serve on the Standing Committee—perhaps I am grateful for being spared that—I should like to refer to what remain the crucial issues in the debate. The questions and answers mentioned during the Secretary of State's speech go to the heart of the subject. Without being personal, I must say that it is a bit much for the chief spokesman and then the second spokesman for the Opposition to come in and go out of the same debate. In the debate about hospital trusts, there were three changes of Opposition Front-Bench staff. That is not satisfactory in terms of meeting one's duty to take responsibility for a debate.
I shall discuss the area that I know best because it provides a good example—the hospital which first looked as thought it would lead the way to opting out, Guy's hospital. My first question relates to the options put in the ballot. The Secretary of State said that there had never been, under either a Tory or a Labour Government, any ballot to decide on a change of management like this. I


accept that that is the case in the Health Service. I accept that one can argue that it is merely a change in the management structure and that the hospital will stay within the Health Service so a ballot may not be necessary. Under the Prime Minister's premiership, the Government have introduced and argued for ballots when there has been a change of management—not a complete and fundamental change—in two different sectors.
Both examples occurred in my constituency, so I know them well. In the education system, parents have taken part in ballots to decide whether schools should opt out of the control of the local education authoity to become grant maintained. The London Nautical school, which is just up the road and is on the Lambeth-Southwark boundary, did that.
Provision was made also for ballots of tenants when someone wants to take over their property or, more importantly, when there has been a change of management, not from the public to the private sector, but from one part of the public sector to another—from the local authority to a housing action trust. As the Secretary of State will remember, at the end of the debate on the Housing Bill, the then Housing Minister decided that housing action trust sites would come into operation only if there were a ballot of tenants. There are therefore precedents for consulting, by ballot, the people affected when a change of management occurs.
I should like to explain why the Secretary of State should consider even now the validity of ballots. The Health Service needs the confidence and commitment of the people who work in it. It is abundantly clear that certain parts risk not having the staff that will be needed in years to come. Nursing is an obvious example, because of demographic trends. If changes are to take place with the confidence of the Health Service—I am talking not so much about the confidence of the doctors outside the hospitals as about the confidence of the doctors, nurses and other staff in the hospitals—is not it important that they should be persuaded of the merits of the case?
After informed debate, those staff should be able to judge the merits of the case. We will have had the White Paper, the Bill will have been considered for a year in both Houses and consultation will have taken place—the Secretary of State said that there will be further consultation—so surely at the end of that series of exercises there is no reason why all the people concerned should not have the full information and the ability to decide between the options. The Secretary of State would be wiser, in the interests of the Health Service, to allow people to pass that judgment.
It is not as if there will be self-governing hospital trusts in every health authority; clearly, there will not. There will be an option between places that will have a self-governing trust and others that will not. The Secretary of State has confirmed that some of the hospitals that were originally in line for going to self-governing status are no longer regarded as being in the first wave. There will be an option. Under the scheme of the Secretary of State, in two to six years' time there will still be hospitals that are integral parts of the local health service with their local health authorities. They will not be separated in the way on which the debate has been concentrating. If that is the case, the

option between having and not having self-government is realistic and should be available to all. It is important to take account of the views of those concerned.
There is—and I say this with real feeling—an enormous public demand to participate in the decision. If we are to keep the public involved in the Health Service and to ensure that they feel that it is their Health Service, the last thing we want to do is to make it look as if decisions are made by a handful of people, let alone one.

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Dame Elaine Kellett-Bowman: Paragraph (2)(b) of the new clause says,
In any case where a majority of the patients of the hospital or service reside in a single borough or district council".
Forty-nine per cent. of those coming to Royal Lancaster infirmary come from all over Cumbria. What happens to them? That figure applies only to one specialty. It is a massive problem in all specialties and the new clause would give the 51 per cent. an enormous power over the 49 per cent. How does one define a constituency for that sort of situation?

Mr. Hughes: That is a proper and important question. I want to link it to the key question. In the interchanges in the speech of the Secretary of State, we did not get to that question and I should be grateful if I could attract the attention of the Secretary of State to this crucial point. The hon. Member for Lancaster (Dame E. Kellett-Bowman) asked how one finds a proper constituency for a ballot of the public.

Dame Elaine Kellett-Bowman: I was also talking about a majority.

Mr. Hughes: I understand that. The hon. Lady will appreciate that my London constituency contains a teaching hospital. In her constituency and mine, enormous numbers of those who use the hospital come from outside the local health authority. The only proper constituency is the area of the health authority at the moment. That brings us to the last questions in the interventions in the Secretary of State's speech. His arguments seemed to be quite plausible arguments for cross-charging and for saying that if people come from outside a health authority to use its services, such as in Lancaster or my constituency, they should bring their fees with them, quite compatible with saying that that will encourage good standards and good practice because it means that if Lancaster royal general hospital——

Dame Elaine Kellett-Bowman: The Royal Lancaster infirmary.

Mr. Hughes: If the Royal Lancaster infirmary or Guy's hospital is doing a good job and attracting people, they are getting paid for the work that they do, which is proper. However, it is not necessary for the consequence to be that they separate the local hospital from being the automatic provider of hospital care for the community with which it is geographically and traditionally associated.
I support the idea that the hon. Lady's health authority should be able to charge the authorities that send patients to it for the proper cost of their care. If a hospital did a good job, therefore, it would stand a chance of having more income and being able to develop its services. If it did not do a good job, people from outside the hon. Lady's


district health authority would go elsewhere. People from outside my district health authority might also go elsewhere.
The Secretary of State did not give a word of explanation of why that requires separation of hospital from health authority. There are still grave reservations not about the principle that hospitals should be paid for what they do and that good practice should be thereby encouraged, but about the principle of separating health authority and hospital. If Guy's hospital opts out, how can that be compatible with tradition, general interest and proper democratic procedures? In the context of tradition, Guy's hospital, like some others, was set up by a 1725 Act of Parliament. It was founded with the money of Thomas Guy, a Southwark man, and its duties were set out by that statute, which made it clear for whose benefit the hospital should be provided. It said in the will of the benefactor, provided for in the Act, that the hospital should be
for those who are thought capable of relief by physical surgery; several species and kinds of sick persons deemed or called incurables; and … the time of continuing them in hospital to the discretion and pleasure of the trustees.
Although that was stated in 18th century English, the purpose of the hospital—which was set up to deal with those for whom St. Thomas's in those days could not deal—was to care for the long-term sick, people in need of convalescence and the poor. All the evidence that I have been able to accumulate makes it clear that the motive for founding Guy's hospital was not simply to provide acute services but to provide long-term services. There is ample evidence concerning the purpose of the hospital.
The 1990 version of that is a hospital which must meet the range of services—from the most difficult internationally reputed specialities and operations for which people come to Guy's from all over the world to see consultants who are world famous—and be a local district general hospital, providing services which, by any definition, are not cost efficient or profitable, such as geriatric care and so on.
The great concern—in saying this I hope that I do not misrepresent the views of the local community—is that all those services that are not so high tech, high cost, high turnover, high quality and high profit could be at risk because they may not come within the obligatorily provided services.
The bulk of people in my constituency—there must be some also in the Secretary of State's area—rely on the local hospital because they are at the bottom end of the income scale and have worse health than many people in the country. They suffer from bronchitic, arthritic, chest, lung and other disorders and they need to be assured that they will have a local health service. They fear that they will not, because it will not be compatible with the cost criteria for the local hospital to continue to provide everything. They fear that the least cost-beneficial services will have to go.

Mr. Kenneth Clarke: I had better intervene now in this mini Adjournment debate, as it were, on Guy's, and Lewisham and North Southwark, because I may not have a chance to do so later. What the hon. Gentleman is saying is relevant because it provides a good vehicle for discussing self-governing NHS trusts.
What the hon. Gentleman says is true of all the London teaching hospitals. They are crowded together because originally they were put here to serve the poor of the teeming London slums. They provided free treatment to

the residents of those poor districts in exchange for the residents allowing themselves to be used for medical teaching, training and research.
Now, a high proportion of that population in most of London has gone away from the area of the hospitals, so we have extremely up-market, high-tech centres of excellence, with international-quality surgery being done in the teaching hospitals which were established for another purpose. I accept the hon. Gentleman's underlying point. I am not attracted by the idea, any more than he is, of some of the London teaching hospitals becoming high-tech centres of international excellence that give up their contact with local services. They will not do that because it is more profitable; as I tried to make clear earlier, the geriatric services will enter into contracts with the NHS that will cover the cost.
I understand that those who favour self-governing status at Guy's are contemplating a merger with the Lewisham hospital, although I do not know how that affects the community services associated with those hospitals. Contrary to popular belief, we are leaving it to the local people. However, I have encouraged those in favour of self-government to look at configurations that will ensure that Guy's stays tied in with what I recognise as one of its fundamental objects: serving the local population in Southwark and Lewisham. I shall certainly use that criterion to judge any application that is made, and it will virtually swamp the public consultation to which I committed myself a few moments ago.

Mr. Hughes: Although what the Secretary of State has said may apply most acutely to the London teaching hospitals, I am sure that the same sentiments are felt throughout the country. I was born in the north-west. in Stockport; no doubt those who use Stockport royal infirmary will feel the same. I was brought up in south Wales, and no doubt those who use Cardiff royal infirmary will feel the same, too. There may be a difference in the degree of feeling, but not in the principle. People want their local hospital to be able to provide the range of services that it provides now, with no prejudice to the least glamorous aspects.

Mr. Peter L. Pike: Indeed, it is not a Guy's issue or a London issue. The people of Burnley certainly want to be treated at Burnley general hospital. They feel that they are entitled to the best possible treatment locally, unless they need recourse to a specialty for which they know that they must go elsewhere.

Mr. Hughes: I am sure that the Secretary of State recognises the feeling on both sides of the House—and I am sure that his friends in Kent and Hertfordshire agree—that, if possible, those who wish to receive treatment locally should be able to.
The system for deciding which hospitals should become self-governing is regarded with great suspicion. I have considerable respect and some affection for—and many dealings with—some of the senior people involved in the Guy's proposal, and I know that they have the interests of the Health Service at heart. I believe that, at the time of the debate on the Health Service in the 1980s, they would have opted for a system of district cross-charging rather than for the Secretary of State's proposals. That would have been a much better idea.
Lord McColl of Dulwich and all the other protagonists—in general terms, that is—have accepted what they see as


the second-best option, encouraged by a fairly self-evident "carrot": if Guy's goes first it will be looked after. They are clearly attracted by the finance that they would secure for their hospital and teaching facilities as a result of its being the apple of the Government's eye.
What worries ordinary people, however, is that the decision will eventually be made by the Secretary of State, after he has been approached by a mere handful of advisers. We all know that tradition removes Secretaries of State from the direct sentiment of local people. I do not criticise the Secretary of State personally; he must know that any Minister who runs a Department that spends such huge sums finds it impossible—with the best civil servants in the world—to be as much in touch with local feeling as he would like, as any ordinary Member of Parliament is with the community.
The problem is that the Government will want the scheme to succeed, and will want hospitals to opt out to show that it can succeed, even if there is mass opposition from all but the handful of people whom the system empowers to put the idea on the Secretary of State's desk. That is what is wrong with not testing the argument and allowing the whole community to decide through a ballot.

Mr. Flannery: During the past year we have been unable to discover from the Government exactly who would make those decisions. Members of Parliament from Sheffield had meetings with the health authority and about two months ago, more by way of a slip, it admitted that it was a group of consultants. In the meantime, outside the Northern general hospital, a group of local people set up a table with a petition on it against the proposal. People in the hospital got out of bed, put their clothes on and went outside, down the drive, to sign the petition. People passing and going into the hospital signed the petition and none was in favour of the decision.

Mr. Hughes: I think that that is right. The Secretary of State must know. I have met no one in favour of the scheme. That is not because they have misunderstood it. I am talking about many well-informed people in the Health Service and outside it. New clause 4 allows the Secretary of State to put his argument that there is a better way to run the Health Service to each local community so that it can judge.
I am not here to defend the technical drafting of the new clause and say whether the electorate is correctly defined. I know that there are problems about that. However, the best electorate are not the people who work in the Health Service, but the people who use the Health Service. I have never understood the argument that it is more important to ballot those who work for that employer because, clearly, they have a self-interest and they are traditionally conservative. We all are about our own professions, and I have the same profession as the Secretary of State.

Mr. Hayes: When a hospital closes, which is far more serious than a hospital taking self-governing status, there is no ballot. The proper way of focusing public opinion is through community health councils. Another point that I am sure has been raised many times in the early hours of this morning——

Mr. Campbell-Savours: The hon. Gentleman has not been here.

Mr. Hayes: I have not been to bed yet. I have been here listening carefully. I may go to bed in a minute, but let me return to the point that I was trying to make.
How on earth does one determine, in a place like Guy's or Bart's, who has to be balloted? Those hospitals have enormous numbers of people from an enormous area across all sorts of boundaries. It would be administratively impossible. Is not that the real difficulty about the Opposition's proposal?

Mr. Hughes: If the hon. Gentleman had been here earlier he would have heard me answer that point in reply to the hon. Member for Lancaster. One cannot have ballots for closing hospitals, because that is a decision for which one needs less resource. This is not the same situation. This is a decision about whether to change the nature of the relationship between the local hospital and the local health authority. That is perfectly susceptible of a ballot in a way that closing hospitals would never be, because one would never get the assent of a community. No such parallel can be drawn.
The Secretary of State said that he is aware of private polls that show that a majority of people are in favour of the scheme. The rest of us have not seen those polls. I have seen no public polls to that effect. One poll last week showed that 71 per cent. disapproved of the Government's scheme, 58 per cent. disapproved of their hospital becoming a self-governing trust and 37 per cent. of those who said that they were Tory voters said that the electorate should be the local community.
I should have hoped that the new clause would have more appeal after a second glance. It does not say that the ballot is determinative, and it could be criticised for that. It says that there must be ballots, reports of which must be presented to Parliament. The hospital can be allowed to be a self-governing hospital trust only if that report is approved.
If, on reflection and having seen the difficulty that this part of his scheme has given him, the Secretary of State believes that it is worth ruining the chance to improve the Health Service by staying firmly with this proposal, he is committing a grave error of judgment. I hope that he will realise that this proposal is probably provoking the greatest difficulty for him among the public at large.
I hope that the Secretary of State will realise that if he is determined to offer the opportunity of separating a hospital from a district, a way forward is to say, "I am prepared, as my colleagues in other Departments did, to accept that the public must have a say." If the public have a say, his Health Service reforms may begin to get more widespread approval. If the public are excluded, people will not believe that the reforms are in the interests of the Health Service and the public, and are just more separation according to Tory dogma and a development of the Health Service from one based on care to one based on cost. That is not what any of the public want.

Mr. Redmond: The Secretary of State mentioned consultation. Is it consultation as a PR exercise or meaningful consultation? Given the track record of Conservative Governments since 1979, I believe that when they say "consultation" it is merely a PR exercise. They intend to take no notice of what the people and various groups are suggesting. A recent example of that occurred


over their education and student loans policy. The talk of consultation is a charade. I wonder whether the Conservative Government are aware that a vast number of people in this country place a big question mark over what the Government say? When the Prime Minister and the Secretary of State say that the NHS is "safe in our hands", no one believes them or anyone who tries to kid the public.
I passionately believe in the National Health Service and fully support it, as do the vast majority of the public. There is no doubt that, given the option, the public would contribute a little more in taxes or another form, to ensure that they have a viable, efficient Health Service that meets their needs. Regrettably, Tory dogma stops that happening.
For the Government, opting out is not one step but one of a series of steps towards the privatisation of the Health Service. I will oppose it in every possible way because the public certainly want a Health Service, and the House has a duty to provide it.

Mr. Jack Thompson: There is another aspect of the opting-out proposition in relation to hospitals. A new hospital is being built in my constituency; the Secretary of State is coming to lay the foundation stone next week. I shall not comment on what my constituents say that they should do with the stone. I suspect that the new hospital will not get the chance to opt in, but will be opting out from the very day it opens. We can look forward to a future of new hospitals being built that will always be opting out and never opting in.

Mr. Redmond: There is no need for me to comment because my hon. Friend's point is self-explanatory and well put.
When the Secretary of State lays the foundation stone, perhaps consideration should be given to putting him in a time capsule. He is unique and will be worth a bob or two in years to come.
When I was a Labour member of Doncaster council I served on the Doncaster health authority, and became its vice-chairman. The chairperson was Celia Wilson. She left no one in doubt that she was a Conservative, but her brand of Conservatism was vastly different from the Government's. Tony Dale was the secretary—again, not a Labour supporter—but he was a first-class administrator and was committed to the Health Service. David Eaves, the treasurer, was also committed to the Health Service.
The Government talk about value for money and an efficient Health Service. David Eaves and Tony Dale helped to provide the foundation, the core services and the efficiency of Doncaster health authority. It has one of the lowest administration costs in the country. The major part of its funding is used to ensure that nurses can provide the necessary care for patients. The administration costs are kept down.
Doncaster is a jewel in the provision of health care. But because it has been so efficient the Secretary of State cannot kid me that he is not making a decision on that authority until later in the year. He has already made his decision about Montagu hospital because of political dogma. It is a tragedy and it makes a mockery of his statement.
I am not a gambling man, but I will bet the Conservative Whip £l—[Interruption.] I am not sure whether I am allowed to do that in the Chamber, so I shall make my wager outside. I am convinced that the Secretary

of State has already made the decision about the published list. He referred to the Whitley council. I served on that council, and I carefully studied the various disputes—especially the ambulance dispute. The blame——

Mr. Speaker: Order. The hon. Gentleman is going a little wide of the debate.

Mr. Redmond: I accept that, Mr. Speaker, but the Secretary of State mentioned the benefits of the Whitley council in relation to wage negotiations. Having sat on a Whitley council I am aware of the manipulation by the Secretary of State for Health. It is kidding people to say that the Whitley council can make its own judgment. It cannot.
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The Bill is one of a series of steps towards the privatisation of the Health Service. Everyone is convinced of that. That is one reason why the Government are opposed to the new clause.

Mr. Hayes: On a point of order, Mr. Speaker. It is a very serious matter. I have just returned from St. Stephen's entrance where I saw the shadow Health Secretary in a seated position, with electrodes on his head and surrounded by men in white coats. That may confirm some of the suspicions many of us have had for a long time. Might it be appropriate for the hon. Gentleman to make a personal statement?

Mr. Speaker: He looks healthy enough to me.

Mr. Redmond: If the hon. Member for Harlow (Mr. Hayes) had been in the Chamber as long as we have, he would have heard the explanation. It shows that he was not in the Chamber for the whole debate, which is unfortunate.
I said that the Bill is one of a series of steps towards privatisation. Since 1979 various Secretaries of State have shifted every health authority chairman who has voiced opposition or even raised a question about Government proposals. They have been replaced by the nodding brigade. How can people believe the Conservative Government when they fill the health authorities with people who will not say that enough is enough?
Doncaster health authority has a fair mix from the community. The chairman, who was appointed recently, supports the Conservative party. That was no surprise; we expected it. There is a Conservative majority built into the authority. One problem for the Government is that occasionally the consultants say, "Stop." When the health authority discussed opting out, the two consultants decided that they wanted nowt to do with it, and the health authority decided not to support the opting out of Doncaster royal infirmary and the Montagu hospital.
One reason why the people do not trust the Government is that since 1979 there has been a regrettable lowering of standards, despite what the Prime Minister says at the Dispatch Box about more money, more nurses and more of everything. I wish people would go into wards and open their eyes instead of looking through blue-tinted glasses. Since I finished with the health authority, when I became leader of Doncaster council, my sister has had three major operations, my brother has become a diabetic and my brother-in-law has had two strokes which have left him blind. Unfortunately, I am at that age when many of my friends and colleagues are falling ill and requiring


treatment at Doncaster royal infirmary, the Montagu hospital or even at Hull and Sheffield hospitals. Standards are lower.
No one would praise nursing staff more than I. However, I do not want to single the nurses out. They are part of a team including ancillary workers, from the porters to the people who type and send the notifications of appointments. If one visited a ward now, one should not see a highly qualified nurse dashing round serving cups of tea to the patients. That should be someone else's job. We should not train nurses to perform skills and then employ them as charladies. That is really disgusting. I am convinced that we should ensure that nurses are paid for nursing and not for mashing cups of tea and serving lunches and dinners from a trolley.

Mr. George J. Buckley: My hon. Friend is making an important point. However, with due respect, we are talking about the control of hospitals, not the services within them. In relation to the points about the Government systematically changing chairmen, does my hon. Friend suggest that the Government are practising a form of nepotism in that they are securing positions to control the hospitals so that their clandestine actions in relation to privatisation will meet no resistance? Are the Government doing that systematically as a step towards the privatisation programme for which they have no mandate?

Mr. Redmond: rose——

Mr. Speaker: Order. I remind the House that we are considering National Health Service trusts.

Mr. Redmond: My hon. Friend the Member for Hemsworth (Mr. Buckley) is absolutely right. The Government could guarantee the Conservative supporters.
Doncaster royal infirmary and the Montagu hospital have expressed an interest in the trusts. The two unit managers—Nicholson and Turner—covertly or in some other way, decided together with a small clique to write to Trent health authority and to the Secretary of State. Since then they have spent a fair amount of time—which is money—and a fair amount of real money as well, pursuing an issue that I believe was outside their terms of contract. They are employed by Doncaster health authority, not by Trent health authority or by the Government. However, they connived with one or two other people in the authority to express an interest.
When we tried to discover the names of the people who had expressed an interest on behalf of the people of Doncaster, the Secretary of State informed us that he did not know who had expressed that interest. There is a saying—which is not racist—"They kid niggers in Africa." That is what the Secretary of State is trying to do. He is trying to kid us. He knows the names that were submitted from Doncaster.
When the Secretary of State was pushed because we wanted to know the facts and started to apply pressure, we were told that the unit managers had expressed an interest, that the consultants had carried out a ballot among themselves and that they supported the expression of interest. However, it turned out that the chairman of the consultants—of the medical panel—had done his own

thing and consulted one or two cronies. Having consulted a minority, he decided that he would follow the example of the Secretary of State and allow the minority to dictate to the majority. Although there were no proper consultation, the proposals went ahead.
My hon. Friend the Member for Livingston (Mr. Cook) referred to Doncaster council, which paid for a MORI poll to ascertain the opinion of the people of Doncaster. A survey was carried out, in which MORI, not the council, posed the questions. MORI decided, "That is the problem; these are the questions." When asked, the overwhelming majority of the people decided that they wanted nothing to do with the Secretary of State's proposals on opting out. The community health council also decided that it would not go along with that expression of interest. I have already said that Doncaster health authority has decided not to support the two unit district managers.
Montagu hospital had been earmarked years previously for a geriatric hospital. It was said that the accident and emergency unit would close, that the operating theatre would be lost and that it would become a geriatric unit. Regretfully—for the Government and Trent—the local people fought like blazes and reversed that decision. We now have some fine operating theatres and good improvements, although we still have some way to go. If we had listened to the pundits and to the whiz kids all that time ago, Montagu hospital would simply have been a geriatric unit, but now it provides the services that I have mentioned. It is one of the hospitals that will opt out. Does the House think that the people of Mexborough and the Don valley will stand idly by?
Against that background, I hope that the House will reject the Government's proposals. I have said that I am totally committed to the NHS. I am a blood donor, but hate to think that some of my blood might go to a hospital that has opted out. New clause 4 should be accepted, as should the idea of ballots and referendums—whatever one likes to call them. I hope that the House will support new clause 4.

Mrs. Wise: The Select Committee on Social Services made a recommendation on balloting, which is the subject of new clause 4. The paragraph with which I am concerned in our eighth report, which was issued in July, begins with some sentences that were agreed by the whole Committee:
The proposal for self-governing hospitals within the NHS is controversial. The Government is pressing ahead very fast with its plans, despite the fact that the basic cost accounting systems … needed to provide the foundation for the establishment of trading in the NHS generally, and of self-governing hospitals in particular, have not yet been fully developed. Unnecessary haste with one aspect of the planned changes may make it impossible for others, including the planned budgets experiment, to work.
That was accepted without any attempt to amend it. The paragraph continues, and this was the subject of an unsuccessful amendment to delete the passage:
If self governing hospitals are to be implemented, they should be phased-in like GP budgets. If this is to be a consumer-oriented revolution, as the Secretary of State claims, the first such hospitals should be set up in districts where there is only one district general hospital serving that area and where customers in the district, i.e. the local population, have indicated through a ballot that they support the hospital becoming self-governing.
That is the very point at issue in new clause 4. The recommendation was approved by a majority of the Select


Committee. It was not done on the spur of the moment. The Select Committee devoted two full sessions to examining the resourcing and structure of the NHS.
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When the vote was taken, those who supported the recommendation were not all Labour Members. They were two Labour Members, two Conservative Members and an Ulster Unionist Member. The House will agree that that was a fair spread. Three Conservative Members opposed the recommendation. Of those three, only one had served on the Select Committee during the whole of the inquiry. If we take away the vote of another member of the Select Committee who was not present during the whole inquiry, and my vote on the grounds that I am Labour so I would vote that way, the remaining members, all Conservative, supported the recommendation by three to one. Conservative Members of the Committee who took part in the whole inquiry, supported the idea of a ballot by three to one.

Ms. Primarolo: Did the Select Committee refer to the position that arises when an entire district health authority prepares to opt out as is the case with the Bristol and Weston health authority? The authority seeks to take all hospitals out.

Mrs. Wise: Some anxiety was expressed on that point from time to time, but most of us thought that it would be improbable. Although we want to retain an integrated service, that method of remaining integrated would, I think, not meet with much favour on the Select Committee.
I have compared the provisions of the new clause with the recommendation of the Select Committee. The new clause is both more cautious and more comprehensive than the Select Committee's recommendation. It is more cautious because it does not give the last word to the ballot of the population. It gives the last word to the two Houses of Parliament.
The new clause is more comprehensive in ways which have merit. It accepts the notion of a ballot of the population. That is crucial. I hope that my hon. Friends on the Front Bench have been influenced by the deliberations and recommendations of the Select Committee. But my hon. Friends have gone further. They have met the Government's argument that perhaps the electorate would lack expertise. The new clause remedies that by making sure that there would be a ballot of the staff. That provides expertise from clinicians and those working daily in the hospital concerned, which is a valuable addition.
My hon. Friend the Member for Livingston (Mr. Cook) explained in detail how the new clause takes account of the district health authorities' views also, and requires that they be made known to the House. That point would not necessarily have commended itself to me immediately, but my hon. Friend was convincing. The new clause draws in administrative expertise. Because his speech was rather too short, my hon. Friend did not explain that the new clause also brings in the views of any relevant CHCs. The Government have not paid attention to that. Indeed, it has scarcely been touched on. Perhaps the Government do not want CHCs' views to be made known because the Association of Community Health Councils has already made clear its strong reservation on the whole matter.

Mr. Flannery: Does my hon. Friend agree that clearly, whoever is balloted, the Government believe profoundly that they will be defeated in every single aspect of democracy? Therefore, to subvert that, they must have recourse to diktat. Diktat is now the order of the clay because they have smelt defeat if they engage in democracy.

Mrs. Wise: I fear that my hon. Friend is right.
My hon. Friend the Member for Livingston referred to various ballots which have taken place. I shall quote from evidence to the Select Committee, particularly choosing bodies for the range of interests that they represent. They are not trade unions. There was considerable unanimity on this point across a wide range of organisations.
The Maternity Alliance is a broad organisation devoted to the needs and wishes of pregnant women. It pointed out:
Within many hospitals' obstretric units women are now getting more choice about how they give birth but choice about where they do so has been restricted by closures, usually of smaller units. This has meant that many women now have to travel further for their maternity care. The Maternity Alliance is concerned that, under the new proposals, the economics of competition and the creation of self-govermng hospitals will further concentrate services.
It points out how that would be a drawback for women:
A more patchwork service would mean more trawl.
It expands on that point, but I shall not detain the House. I recommend the evidence to the House.

Mrs. Mahon: In Committee I moved an amendment to include maternity services in core services. As my hon. Friend the Member for Livingston rightly said. core services have disappeared from the Bill. The Government refused to include them. That shows their lack of commitment to a comprehensive Health Service.

Mrs. Wise: My hon. Friend makes a good point. Undoubtedly not only the Maternity Alliance but bodies such as the Royal College of Midwives have expressed grave reservations about the fragmentation likely to result from these proposals.
Even allowing for our wholly disproportionate reliance on hospitals for childbirth, pregnancy and childbirth necessarily involve the community, then the hospital and then the community again. Fragmentation would be extremely dangerous—and I use that word advisedly—for the care of expectant mothers.

Mr. Rogers: My hon. Friend rightly mentioned that women now have to travel considerable distances for their children to be born, because of communication difficulties, and that is a real problem in the south Wales valleys and particularly in the Rhondda valley.
I am glad that we have been joined by the shadow Secretary of State for Wales and the shadow Health Minister for Wales, because I hope that they will be able to correct that situation when they come to power. One of the greatest things that can happen to a person in Wales is to be born in the Rhondda. That is not only considered to be a distinction; it is a distinction. However, women in East Glamorgan have to travel to be delivered of their children; due to Government cutbacks children cannot be born there. In a tribal area such as the south Wales valleys such an issue is of considerable importance. I know that the shadow Secretary of State for Wales will put this issue high on the agenda when we win the election next year.

Mrs. Wise: The Medical Women's Federation said:
Implementing change without consulting those on whom the burden will fall flies in the face of good management practice and demonstrates a discrepancy between this Government's self image and its behaviour.
The federation went on to make even less complimentary references to the Government, but in deference to the fact that they are having a hard time today, I shall not quote any more.
The Royal College of General Practitioners, speaking about independent hospital trusts, said:
The College feels that the proposals for independent hospital trusts will seriously affect the level of services for patients and training. The creation of self-governing hospitals will de-stabilise future community care and may lead to a fragmentation of services.
Perhaps that is the sort of evidence that has led the Government to believe that it would be highly dangerous for medical opinion to be consulted and to be laid before the House; the Government think that they will lose.
The Health Visitors Association is concerned about another aspect that has been somewhat neglected. Community services as well as hospitals can opt out of control by the community through the district health authorities and that is an extraordinary proposition.
The Health Visitors Association is deeply worried about that because, by definition, health visitors are in the community. It said:
A possibility not touched on in the White Paper and Working Papers (except implicitly in the references to health authorities being empowered to buy services from the private sector) is that a private company could bid for the contract to provide all or part of the community nursing services. While the Government's stated intention is for careful regulation and monitoring of contracts and their performance, the Association believes that specific safeguards are needed to prevent vested interests from developing services in directions detrimental to the interests of clients. An infant formula manufacturer, for example, should not be able, by any act or omission, to create conditions within the health visiting service which would adversely affect the quality of unbiased information and advice about infant feeding.
That is a matter of great concern, which the Government have not referred to at all. They are not privatising the NHS—I will concede that—but they are blurring the edges and the interface between it and the private sector, which will result in a most peculiar and uncontrollable hybrid.
The Health Visitors Association has proven knowledge of and a proven interest in the matter. It would welcome the opportunity to ensure by means of a device such as new clause 4 that its concerns were put directly to the House.
The association also referred to the integrated nature of the service. It said:
Integrated child services ensure close links between the nursing and medical staff, in and out of hospital, concerned with a range of provision for children with special needs, and in relation to child protection. Where these aspects of hospital and community services were no longer to be managed by the same agent, the Association fears that these links could be jeopardised, particularly if they added to the hospital's costs.
The last phrase—
particularly if they added to the hospital's costs"—
contains a considerable sting. It will determine what a hospital does. I agree with the association that the kind of services to which it refers, which are so important to children, would be jeopardised.
The Division of Social Responsibility of the Methodist church also submitted evidence. I accept that the term "social responsibility" might invalidate the Methodist

church's evidence in the eyes of Conservative Members, but that will not apply to the public. The Methodist church's response to the Select Committee's report was:
NHS Hospitals may opt out of Health Authority control. They will be managed by business-oriented Trusts, which may trade with other institutions, private and public, hiring their own staff at their own rates.
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The Secretary of State compared this reorganisation with the 1972 reorganisation—again by a Conservative Government. I was not predisposed towards that reorganisation, but it bore no relationship to these proposals. The Secretary of State relies on people not having read the documents relating to his proposals. The Methodist church referred to the relationship with the private sector and said:
There is no reason to welcome the expansion of the private sector; countries with a larger proportion of health care provided privately do not always enjoy better health care than does Britain. The White Paper envisages the NHS working much more closely with the private sector. In view of the proposals to bring senior clinicians more closely into management, this implies a very serious conflict of interest. Consultants are likely to have a fairly dominant role under the new proposals, and would be chiefly responsible for buying services from the private sector, that is, from their own medical businesses. This is seen as corrupt when it occurs in the Local Authority context, and will place a heavy policing burden on the Audit Commission and on Health Authorities.
The deep suspicion arises, however, that the plans for hospital trusts are designed to make large-scale privatisation possible.
That is not a Labour party document; it is a document from the Methodist church's Division of Social Responsibility.

Mr. Hoyle: I am very impressed by my hon. Friend's remarks. Does she agree that, as all this is about cost, there will be a temptation to put pharmacy, laboratory services, and so on, out to the private sector and that, as a result, we shall have an inferior, less efficient service that could put lives at risk?

Mrs. Wise: I agree entirely. As the point that my hon. Friend has made is self-explanatory, I shall not elaborate on it.
As I have shown, the Select Committee took evidence from a very wide range of organisations. It took evidence also from the research team for elderly people at St. David's hospital, Cardiff, which added its voice to the expression of worries and anxieties about the likely consequences of the Government's proposals. No doubt, those people would like a chance to be consulted. The research team told us:
The interface between community and hospitals, including flexible respite care, is also critical for older people. It is hard to envisage hospitals which become autonomous seeing such work as a priority unless they perceive that such an approach will reduce the readmissions of chronic cases. What evidence exists suggests that elderly people who get into trouble after discharge are not regularly reassessed. There will be no financial incentive for a hospital to ensure that good follow-up and rehabilitation facilities exist. The tendency will be even greater if such reassessment is likely to lead to readmission, thus incurring heavy financial disadvantages. Unless the auditing system extends to surveillance of the community, these failures are unlikely to be recognised.
I suggest that the people who would recognise these failures, and indeed would be in a position even to anticipate them, are elderly people themselves. Thus, those who care for them clinically and those who carry out


research on the subject should have the ear of the House, as should the elderly people themselves, by way of the proposed ballots.
The case for a ballot has been made not so much by Opposition Members as by all these outside organisations with their expertise and their interest—and that cannot be said to be simply self-interest; the range is far too wide for that. I could have quoted many more instances. As it is, I have quoted a very wide range of people with an excellent reputation and with expertise.
I believe that the new clause, because it would give the final say to both Houses of Parliament, is cautious. It is also comprehensive, in that it brings in clinicians and other staff, district health authorities and community health councils, as well as the local population, and ensures that the Secretary of State is obliged to include their views in any report on proposals to opt out. He would not dare proceed against the weight of the opinion that would be disclosed. That is why the new clause is being resisted so fiercely by Government Members.

Mr. Terry Davis: The Secretary of State complained at the beginning of his speech that my hon. Friend the Member for Livingston (Mr. Cook) had spoken for a long time in moving the motion on the new clause. The Secretary of State spoke for one hour and 11 minutes and did not get to the point of the new clause until he had spoken for one hour and six minutes. By contrast, like my Back-Bench colleagues, I shall devote all my remarks to the purpose of the new clause, which is to ensure that there is a consultative ballot of local people about the future of their local hospital.
The Secretary of State is not in the Chamber. He told the House that he intended to make a special point of being present for speeches by Back Benchers. He left the Chamber almost as soon as they started to make their speeches. His absence is particularly unfortunate because I intend to take him to task for his remarks about the ballots held in some parts of the country.
I speak for the west midlands. The Secretary of State announced in a press release that five "units"—the Government's word—have expressed an intention to opt out of local health authority control and become self-governing trusts. I was interested to note that the first of the units on the list promulgated by the right hon. and learned Gentleman is the Alexandra hospital in Redditch. It is first because the list is in alphabetical order. The Alexandra hospital is in the area of the Bromsgrove and Redditch health authority, where I lived for many years and which I briefly represented in the House.
A hospital was desperately needed in that new town, and the people of Redditch campaigned for nearly 20 years to get one. Everything else was provided—housing, schools, shops and roads—but the hospital was at the end of the list. A marvellous hospital was eventually constructed a few years ago. Although it does not operate to capacity because of underfunding, it is a tremendous boon to the people of Redditch. However, they have learnt that someone—I believe that it may be the health authority—has expressed interest in the idea of the hospital opting out and becoming a self-governing trust.

Mr. Winnick: My hon. Friend referred to five such hospitals in the west midlands. Is he aware that the opt-out proposal for a district general hospital in my borough has been opposed by the local community health council,

which made it clear in a letter to the Secretary of State that there was no justification for opting out and which echoed all the fears that I expressed in an Adjournment debate on this subject last July? Is not it a fact that there has been no sign of any public support or support from the staff at those five hospitals for the proposal?

Mr. Davis: I am grateful to my hon. Friend. He has saved me from making some remarks about Walsall. I thought that he might want to represent the interests of his constituents.
I shall concentrate at this stage on the Alexandra hospital in Redditch, where a ballot has been held. The Secretary of State referred to what he called fancy polls up and down the country and talked about the Labour party and the trade union movement enjoying themselves organising straw polls to oppose self-governing trusts for NHS hospitals. The people of Redditch will take grave exception to his remarks, because the Redditch ballot was organised not by the Labour party, the trade union or some fancy people but by the local council. It is true that there is a majority of Labour councillors on Redditch district council, but the ballot was supported by all parties, including Conservative councillors who, to their credit, believed that the people of Redditch should be consulted about the future of their local hospital, for which all parties had campaigned for many years. Those councillors went so far as to invite the Secretary of State for Health to launch the ballot. He declined and refused to send a representative. The leaflets distributed by the local council could not be described as propaganda. They set out the arguments for and against a self-governing trust.
When I read the leaflet, I wondered what the result would be, because it gave the Government's alleged advantages of opting out. The ballot was organised by the council officers on behalf of all the council and it was done fairly. There was no bias in either the questions or the explanatory leaflet. Even the Secretary of State would have to concede that point if he took the trouble to look at the leaflet.
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The ballot had a tremendous result. There was great interest in the town of Redditch, and 57 per cent. of the people took part. There was no way in which the ballot boxes could have been stuffed. The ballot was conducted by council officers who visited people's homes to collect the forms, so there can be no allegations of rigging. Thirty-two thousand people took part in the ballot which was organised by all parties on the district council in Redditch. Of those, 3,210 or 10 per cent., having read the arguments for and against, could not make up their minds on whether the hospital should opt out, and 5,262, which is 17 per cent., were clearly in favour of the hospital opting out. The other 22,869 people said that they were against their hospital opting out. That is 73 per cent. of the many people who took part in the ballot and represents 81 per cent. of those who had an opinion, as my hon. Friend the Member for Livingston said. They said that they were against their hospital opting out.
The hospital serves not only Redditch, but the Bromsgrove district. I know that district well because I used to live there. It includes a rural area as well as the town of Bromsgrove and is a large district. It was only right that the people of Bromsgrove should be consulted as well as the people of Redditch, because the hospital serves
both districts. Unfortunately, Bromsgrove district council, which is Conservative controlled, refused to conduct a ballot, so it was left to the Labour party to consult the people of Bromsgrove. Bromsgrove Labour party, to its credit, put a great deal of effort into organising a ballot, which it tried to make as fair as possible. It received a tremendous response, too. There were 20,000 ballot papers and 35 per cent. of the people in Bromsgrove responded to the opportunity to be consulted about the future of their hospital, which is the Alexandra hospital. That is more people than participate in many local elections, as hon. Members of all parties will accept. Having thought about the issue, 238 people said that they were in favour of the hospital opting out and becoming a self-governing trust, whereas 6,812 people said that they were against opting out. Of 20,000 ballot papers, the response was 7,050, which is 35 per cent. Ninety-seven per cent. were opposed to the Alexandra hospital being allowed to opt out.
Another ballot was held, not by the Labour party or by the council, but by the staff for the staff at the Alexandra hospital. It was not restricted to staff who happened to be members of trade unions, but was for all staff. It recognised the right of everybody who worked at the hospital to express an opinion about the future of their place of work. Eighty-three per cent. of the staff took part in that ballot, and the result was similar to the results of the ballots of those living in the catchment area of the hospital. Thirty-one members of staff were in favour of a self-governing trust, whereas 795 voted against. That is 96 per cent. against a self-governing trust and only 4 per cent. in favour. There is no question about the overwhelming opinion of the staff at the hospital, of the people living in Redditch and of the people living in Bromsgrove about the future of their hospital.
What was even more significant in the context of this debate about new clause 4, about whether people should be consulted and whether people should have an opportunity to express their opinion, was the result of the other question that people in Redditch were asked. Redditch council asked the local people whether they thought that they should be consulted. There were differences of opinion about whether the hospital should opt out, 81 per cent. of those who expressed an opinion being against—although the crude voting figures showed that 73 per cent., three out of four, were against opting out, with 17 per cent. in favour and 10 per cent. not knowing.
But when the people were asked whether they should have an opportunity to be consulted, the response was even more impressive. Only 3 per cent. did not have a view about that; 10 per cent. had not formed an opinion; only 7 per cent. were against being consulted; but 90 per cent., including a large number of those who were in favour of opting out, said they should have an opportunity to express an opinion. They were talking about being consulted, not about determining the future of the hospital. That is the purpose of the new clause—to ensure that people are consulted—and experience among the people in the Bromsgrove and district health authority area clearly shows that the public want to be consulted. The Government are resisting the new clause and are thereby saying that people should not even be permitted to give their view.
We are not saying that the local people should determine the future or that the ballot should be binding. The Conservatives are in favour of compulsory and binding ballots when it suits them. Let the people be

consulted and express a view, and let us be told the result. The Government's supporters, Tory councillors and even those who are in favour of the hospital opting out want them to agree to the principle of the new clause.
Five units are now being considered. In other words, in five places an intention to opt out and become a self-governing trust has been expressed. My hon. Friend the Member for Walsall, North (Mr. Winnick) said that the Walsall acute services hospital was one of the five. I have spoken in detail about the Alexandra hospital. It has been suggested that a hospital in Rugby should become a self-governing trust, but unfortunately we do not have an hon. Member among us to say what the people of Warwickshire think about that.
Two other units are outstanding. In those, an intention to become self-governing trusts has been expressed. It so happens that the people served by those two units will be consulted in the most effective way. They will have not just the opportunity but the right to be consulted about the Government's plans, not only for their hospitals but on a wide range of other issues. Those two units are the Mid-Staffordshire mental health hospital and the Mid-Staffordshire community hospital. The people of Mid-Staffordshire will have their say on 22 March. I am confident about the view that they will express, and the Government will be obliged to listen.

Mr. Madden: I need not apologise for intervening in the debate because first, I have been waiting for 16 hours to speak to the new clause and, secondly, I am anxious to report why many people in the city of Bradford strongly believe that the public and staff concerned should be consulted about the Government's proposals for self-governing trusts.
We in Bradford are told that there is to be a trust which will incorporate Bradford royal infirmary, St. Luke's hospital and Woodlands hospital. If that is true, it means that 85 per cent. of all Bradford's hospital services will be included in the trust. There are rumours that a fourth hospital will also be included, although it has not been identified.
Many people in Bradford, and throughout the rest of the country, are concerned about the extensive preparatory work undertaken over the past 12 months to establish trusts, before any parliamentary approval has been given to the Bill that provides for them. Dr. Mark Baker, Bradford's district general manager, has spearheaded the intense preparations for the Bradford trust. He has secured a very unusual agreement with Bradford health authority: he has been seconded to Yorkshire regional health authority for two years, after which he is free to return to his Bradford post if he so wishes.
That unusual agreement underlines the suspicion that the Government see the Bradford trust as the flagship of their proposals to dismantle the NHS there. There is also some significance in the allegation that the Government have allocated £400,000 extra to the Bradford health authority this year: that is clearly intended to facilitate and finance the preparatory work that has been under way during the past year.
Many other worries felt by Bradford people reinforce the need for ballots to be held before NHS trusts become a reality, there and elsewhere in the country. The Bradford trust, unlike the health authority, is not observing an equal-opportunity recruitment policy. Top jobs are being


filled not through open competition—they are not being advertised—but under the old pals act, which many people both inside and outside the NHS find entirely unacceptable.
Furthermore, neither the public nor the press will have the right to attend the meetings at which the trust will determine its overall policy on patients and other important matters. That, too, is causing widespread concern. Officers who intend to become directors and officers of the trust have been drawing up their own trust contracts, and dealing similarly with other matters in which they have a direct financial interest. Some have received large bonuses to speed the development work. It is feared that after April 1991, when the authority takes on its new contracting status, it will be left with a rump of officers unable to compete with the much more powerful sole supplier of core services—the trust, whose directors will know the health authority inside out. That is no way in which to operate a contractor-contractee relationship.
This year, the health authority's budget of £80 million has had to be cut by £3 million. Chronic services for the elderly, psychiatric patients, disabled and handicapped people, and the community services, have been cut by £1·2 million, whereas acute services, have been cut by only £300,000. That has occurred against a background of continuous concern about underspending of the chronic services budget and overspending of the acute services budget.
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We know that the acting unit general manager for chronic services is planning to go to the trust as Dr. Baker's deputy. That man is in charge of the cuts programme in chronic services, cuts which protect acute services and make the trust more financially viable, and which are thereby of direct future financial interest to himself and in conflict with his present responsibilities to do the best that he can for the chronic and community services. It has been freely admitted that part of the cuts will entail job losses in the geriatric and school nurse services.
There is serious anxiety about the trust's employment policies. On 13 February 1990, Mr. Charles Vize, a senior consultant for the ear, nose, throat and eye unit, who is to become the clinical director of the Bradford trust for those specialties, met nursing staff at Bradford royal infirmary and told them that the Whitley council's terms and conditions of service, at present recognised by the Bradford area health authority, would not be recognised should Bradford become a self-governing trust. They were also told that flexible working patterns are to be introduced in the ear, nose, throat and eye unit in the near future with or without members of staff approving them, and that members of staff would be liable to summary dismissal and would lose the right of redress.
As I have already said, night sisters in Bradford have been told that under the trust those posts will be abondoned. A night sister working in Bradford wrote to me saying:
I am now told that I am no longer necessary and I am very worried and concerned for my patients and my staff. Who will help and support my staff, some of whom are newly qualified … At the end of the day it is the patients who will suffer … I feel angry, hurt and let down that after all these years my services are no longer required. I worked for many years on a low salary but because we were classed as dedicated this was acceptable. Now when I am receiving a decent salary I am classed as an expensive commodity and out I go. Do the

public realise that there will be no Health Service as we know it if the White Paper is passed through Parliament? I would appreciate any help that you can give me.
That comes about because I understand that under the trust there is to be rotating 24-hour staff cover and night sisters will not be part of that. There will be only day sisters; night sisters' posts will be abolished. They are worried about whether alternative vacancies will be offered to them and whether those posts will be on a comparable grade, and there are real fears that a number of night sisters now doing dedicated and caring work in Bradford are likely to be made redundant in the near future.
I have also received letters from junior doctors in Bradford. They have recently formed the Bradford junior doctors committee and they are campaigning about their excessive hours of work which range from 90 to 120 hours a week. They write:
We feel that now is the time for action. Bradford Area Health Authority have expressed an interest in "opting out" and are putting a lot of behind-the-scenes effort into this, but none into improving our working conditions. Things will only get worse if opting out becomes a reality.
In the view of many of my constituents and the majority of people of Bradford, the Bradford trust and the aura that is being created around it, is producing an unacceptable atmosphere of secrecy, sleaze and self-interest. Instead of health care, there is talk about business plans. Instead of talk of patients there is talk of customers. The principle of the National Health Service was put to the people of this country at a general election and the Labour Government in 1945 received a massive mandate for it. The proposals fundamentally to dismantle the National Health Service should, in turn, be put to the people of this country at a general election. Therefore, the Government should call an immediate halt to the preparation for National Health Service trusts throughout the country. We are told that 16 will be announced this October, and another 40 or 50 next year.
It is wholly unacceptable, and possibly unlawful, that preparatory work for those trusts has gone on in Bradford and elsewhere during the past 12 months—months and months in advance of parliamentary approval. If the Government are not prepared to accept the recommendations in the new clause that extensive and thorough consultations with staff and the public should be undertaken in properly supervised ballots, they have no alternative but to withdraw the proposals, call a halt and allow the people of this country to show clearly at a general election whether or not they support the fundamental dismantling of their National Health Service.

Mr. Keith Bradley: I am grateful to be called after 16 hours of detailed debate of the Bill to look at new clause 4 in the light of a hospital in my constituency, Christie hospital, a famous national centre of excellence. I wish to show by this case study the process that has been going on over the past 12 months and why the clause is so important. I shall concentrate on subsection (2)(a) of the new clause, which refers to a ballot of staff at a hospital. I specify that part of the new clause because, although I fully support and commend the Opposition calls for wider consultation and ballots among the local community, I accept that, in the case of Christie, patients come from all over the country to use its facilities and there could be an argument—I say no more than that—why the electorate would have to be narrowed down in this ballot.
The people of south Manchester are proud of Christie hospital. They do a lot of work to raise money to ensure that it continues to operate. Without that support from local people many of the services that still exist at Christie hospital certainly would not have continued. With that reservation, I shall limit my remarks to a ballot of the staff.
I shall first make a general comment about the context of Christie hospital. It is in South Manchester health authority. In Committee, the Secretary of State for Health, on one of his rare appearances in the Committee, said that he was fed up hearing about the problems of South Manchester health authority. He is going to hear a bit more about them today.
The chaos of financial crisis in south Manchester continues. It has come to such a point that not only has the chair of the health authority resigned and will not be reappointed from 1 April, but the general manager leaves tomorrow. Three months of consultations have just been completed on a document containing plain supposedly to rationalise services between Withington and Wythenshawe hospitals, has been rewritten and a new document was to be presented to a health authority meeting this Thursday. At 11.30 pm yesterday I learned that that meeting has been cancelled and no meeting to discuss the consultation document will be held before the chairman of the health authority and the general manager leave. Therefore, the financial crisis and chaos in south Manchester continue. We must consider the proposals for Christie to opt out in that overall context.
It has been clear from the start that any expression of interest by the consultants and staff at Christie hospital to opt out of South Manchester health authority control has been based exclusively on the lack of resources within South Manchester to provide the amount of care that the hospital wants to give. There was an Adjournment debate on that very subject in 1986. If those resources had been made available to Christie hospital, recognising it from that point as a centre of excellence, there would have been no expression of interest in opting out. It is the last resort to gain some extra resources; a cynical attempt to grab what money may be available to prop up a failing service.
Even that expression of interest was not unanimous. A ballot was held among the consultants and, by only a narrow majority, they decided to express an interest. However, it was made quite clear that that was only so that they could receive more information about opting out. There was a clear understanding that no decision had been taken about opting out, that the information from the Department would be studied, and a decision then made.
However, based on that expression of interest, the whole bandwagon got under way at the hospital. The general manager, Mr. Fry, wanted to push ahead as fast as possible and to retain the hospital's position on the short list for being one of the first to opt out. He was egged on by a few consultants, and the whole process moved on.
Hon. Members have already mentioned the amount of work done in hospitals even before the Bill has completed its stages. Already a draft document is ready to be presented to the Secretary of State. A great deal of management time and expenditure went into that which should have been spent on health care for South Manchester. It is a scandal and the Secretary of State should be here to try to defend that.
What is the process of consultation to discover whether that vague expression of interest has any validity among the staff of the hospital? The Labour party has been accused of trying to influence public opinion on opting out by putting out misleading information. What did the management of south Manchester do? It regularly produces a good-news newspaper for the health authority called "Health Call". That is distributed to all the people in South Manchester. Throughout the financial crisis in South Manchester, when wards and even whole units have been closed and waiting lists have grown, with consultants saying that people are dying because they cannot be admitted to hospital, did the newspaper mention those facts? Not a word—it is all good news. It contains articles such as
Why Christie's may opt for self-government
with a nice picture of a smiling general manager exploding the so-called myths of what is happening.
Follow-up propaganda—a nice, glossy magazine—was also produced at the health authority's expense to explain why the hospital should opt out. It is probably only a coincidence that it is on blue-headed paper. It gives the management's position and then devotes a whole page to
Some myths associated with self-governing status.
The general manager, in his unbiased presentation of information for the staff on how to reach a decision, quotes the supposed myth:
When health authorities or GP budget holders run low on funds, patients will be denied treatment.
He then asserts:
Not true. The Department of Health has stated many times that … no patient will be denied treatment solely on the grounds of lack of cash.
However, when we tabled an amendment in Committee to ensure that no patient would be denied treatment because of lack of funds, the Government refused to support it and voted it down. Therefore, the "not true" assertion of the general manager of Christie hospital has exploded in his face. It is party-political propaganda to try to kid the staff that it will be in their best interests to opt for self-governing status. That flies in the face of the Government trying to accuse the Labour party of undertaking such propaganda exercises.
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What is the process that Christie will undertake? The whole basis of the expression of interest has been on that one vote among the consultants. They have continued down the path. Now there is to be a series of consultative meetings with staff in the hospital. When the general manager was asked to have another ballot to see whether the expression of interest had been firmed up, he said that it was not possible to have a ballot because he could not identify which population should be balloted. When it was accepted that the ballot should take place only for staff in the hospital, he wondered whether all the staff should take part, or whether part-time staff should be allowed only half a vote. He refused a ballot and said that he would arrive at a consensus which would emerge from the consultative meetings. When he was asked how it would emerge, he replied that he would gauge the mood of the staff meetings.
The position is reflected in a copy of a letter that I received from a consultant who is happy to be named. Mr. Martin Harris wrote to the general manager:
I have read the Draft Application for Self-Governing status for the Christie Hospital, and I do not believe that it


sets out a convincing case that the Hospital is likely to be financially viable as a Trust. Furthermore, I feel that the application is misleading in a number of ways".
He identifies why it is misleading. In the light of the new clause I shall read just the first one:
I object to the implication made at several points that the Application has the support of staff in the hospital. Perhaps it does, but this has not been ascertained by a ballot.
He wanted a ballot and he thought that the votes cast for and against should be identified in the application. The general manager has said that a consensus of support is emerging. Mr. Harris carried out a ballot of his staff and the consultants in pathology and medical oncology. Every consultant was against the proposal, as well as 15 out of 27 staff; 60 per cent. were against the proposal.
Here we have a general manager expressing a view based on no new information from the Department of Health. He has refused a ballot and said that he can gauge the consensus. Yet the evidence is clear that if there were a ballot, the majority would vote against the proposal.
As my hon. Friend the Member for Livingston (Mr. Cook) said, we will not allow the management of hospitals to opt out without a ballot. We will ensure that the staff in Christie hospital have the right to ballot. We will ensure that that is included in any further document and that the people of South Manchester, who care passionately about the future of the hospital, understand that the Government are ignoring the wishes of the staff and of the general public, and are ploughing ahead. That is democracy to the Tory party. We will ensure that democracy is seen to be done.

Mr. Tom Clarke: The hon. Member for Harlow (Mr. Hayes), who is back in his place, raised a point of order earlier. He drew the attention of the House to the presence of some men in white coats. My hon. Friend the Member for Livingston (Mr. Cook) is still here. Until a few seconds ago, the hon. Member for Harlow was missing. I cannot see the Secretary of State. I wonder whether that was the reason for the presence of the men in white coats.
The Secretary of State owes an explanation to the House. Having criticised my hon. Friend the Member for Livingston, who had been present for much longer than he had been, he said that he would listen to contributions from Back-Bench Members. So far as I could see, he did not listen to any. But that is par for the course for him.
New clause 4 is clear, logical and reasonable. I believe that it invites the support of the House and I have no doubt that it has the support of public opinion. The new clause is headed "consultation" and it deals with the essential principle that the Government have adopted of opting out and the formation of NHS trusts. If we still claim to be a democracy, it must be reasonable that patients, workers in the Health Service and communities should have a say in the Health Service in their areas.
I was disappointed that the hon. Member for Southwark and Bermondsey (Mr. Hughes) saw a difference between those who work in the NHS and the patients. I do not believe that the patients see it that way. They accept that they owe a great debt to NHS workers and they would respect the views of the people who maintain the Health Service, of which we have been proud and of which we will be proud under the next Labour Government.
The Secretary of State opposes the principle in the new, clause. However, as we saw in Committee, he does not oppose it on the basis of logic or by embracing democracy.

He does not oppose it because he thinks that it will not improve the Health Service or because the Government are being consistent—and we must remember that we are talking about a Government who imposed ballots on the trade unions, and introduced the same principle to education and housing, but who have now decided that the principle is not practical for health because they know that in every test of public opinion the Government's view would not prevail. The reason for the Government's stand on this clause, as on others, is that we face nothing but dogma, and that dogma is utterly repugnant to the British people.
My hon. Friend the Member for Livingston and my other hon. Friends who have contributed to the debate, including my hon. Friend the Member for Preston (Mrs. Wise) who referred to the view of the Select Committee on Social Services, have made an unanswerable case. The case is so unanswerable that I will conclude by asking the House to take the only reasonable view, which is to support the new clause. If the Government still resist it, I invite the House to divide on it.

The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman): I will endeavour to answer some of the questions that have been raised and if other hon. Members—

Mr. Campbell-Savours: On a point of order, Madam Deputy Speaker—and I am not being unreasonable in raising this point of order.
I understood that my hon. Friend the Member for Monklands, West (Mr. Clarke) rose to ensure that a closure would not preclude a speech being made by a Scottish Member on this important matter. If the Minister is taking this opportunity to reply, can we presume that we will not be excluded from the debate? My hon. Friend the Member for Monklands, West was protecting himself—

Madam Deputy Speaker (Miss Betty Boothroyd): Order. That is a very convoluted point of order. Thee hon. Member for Monklands, West (Mr. Clarke) rose and it was my duty to call him as he speaks for the Opposition.

Mr. Freeman: Obviously if the hon. Member for Monklands, West (Mr. Clarke) tries to intervene, I will try to answer any questions that that he may ask.
The hon. Member for Monklands, West made the main point of his attack the fact that we were approaching the establishment of NHS trusts as a matter of dogma. I cannot agree with that. I believe that there is sound common sense behind our proposals, because we are not taking anything away from the NHS. We are not taking anything away from the people of Manchester, Withington, of Birmingham, Hodge Hill or of Bradford, West.
Through the delegation of greater responsibility to hospitals, mental health services, ambulance services and districtwide services—there are many different types and models of NHS trusts—I hope that we shall restore more local pride and responsibility in the management of the NHS. I am somewhat surprised at the hon. Gentleman's comment and disagree with him that we are approaching the issue as a matter of blind dogma. I honestly believe that it is sound common sense and later this year when the House sees initiative covers a relatively modest number of hospitals and other units, hon. Members will recognise that it is a sound and sensible initiative——

Ms. Primarolo: I apologise for interrupting the Minister so early in his speech, but he said that a relatively small number of hospitals and units were involved. The South-West regional health authority contains 11 district health authorities. Currently his Department is planning for eight of those DHAs to be removed to trust in their entirety. That is not modest; that is not a small number; it is almost all the NHS provision in the South-West region in its current form.

Mr. Freeman: I do not believe that the hon. Lady has got her statistics right for two reasons——

Ms. Primarolo: I am referring to the Minister's press release.

Mr. Freeman: First, we listed 79 potential NHS trusts several months ago, ranging across the board from services within an entire district, to an acute hospital, to an ambulance service and a mental health unit. There were many different examples. I hope that I have made it clear to the hon. Lady that when my right hon. and learned Friend the Secretary of State launches the initiative once the Bill becomes law, we shall be dealing with a relatively modest number. There are 260 major acute hospitals in England of which a relatively modest number will join the initiative.
The main thrust of the earlier remarks of the hon. Member for Bradford, West (Mr. Madden) was that he questioned the validity or the constitutional propriety of such preparatory work. I do not think that he used the word "illegal". He knows that this matter has recently been tested in the courts and that a clear judgment was reached, ruling that the preparatory work undertaken so far was legal. I assure him—as did my right hon. and learned Friend—that no definitive steps will be taken until Parliament has given the Department of Health the necessary authority. The preparatory work is prudent and modest. Whatever Government were in power and planning any change in the NHS, for whatever reason, I believe that they would have sought to take such steps.
The hon. Member for Birmingham, Hodge Hill (Mr. Davis) said that the public would not be consulted. I think that that fairly reflects the hon. Gentleman's concluding remarks. I am sure that he did not mean that we would not go through the regular consultation procedure involving the community health councils when the Bill is enacted. Through the community health councils of those districts where NHS trusts are recognised as potential candidates, there will be a process of proper consultation lasting several months which will involve the community health councils offering their opinion, ascertaining the views of the public through media advertisements and doubtless through the canvassing of the hospital staff, both medical and non-medical. All those views will be sought and, I am sure, expressed. We are not proposing in any way to change the existing procedure by which the community health councils can express their opinions on what will be a significant change of a delegation of authority within their districts.
We believe strongly that a formal ballot is unnecessary because we are talking about the delegation of authority. We are not taking anything away; we are not removing a hospital from the Health Service. The units will remain within the service. We are delegating authority and therefore we believe that a ballot is unnecessary.
We are delegating——

Mr. Bill Michie: In all the consultations that have been guaranteed and taken place in the past, whether involving a hospital or ward closure, the overwhelming evidence from the public, staff and patients has suggested that the place should stay open. Yet after that consultation, the opposite has happened. The results of the consultation have been completely ignored. Therefore, there is frustration. It is fine to have the consultation, but unless the powers-that-be take notice of it and act upon it, it is a complete waste of time. A ballot shows the number of people who believe that such a place should stay open or should not opt out. The evidence is public and should be recognised. Consultation is a con. If we could have some sort of ballot, action could be taken.

Mr. Freeman: It is not fair to say that the community health council consultation procedure—certainly in my experience—has been a con or a sham. It is statistically true that few hospital or ward closure decisions, perhaps as part of rationalisation, are reversed or stopped in their tracks. But the nature of the changes is often altered as a result of representations from the CHC. The qualifications placed on what may happen may be changed.

10 am

Mr. Gerald Bermingham: I have listened carefully to the Minister. He may recall the occasion not long ago when people from the St. Helens area came to see him about the geriatric units there. Everyone, from the community health councils to doctors and everyone else involved agreed that they should not close. The Minister listened to the area health authority and ignored the populace at large. What guarantee is there in what he says?

Mr. Freeman: When decisions do not go in the general or specific direction that hon. Members and their delegations want, they believe that the Minister has listened to the health authority. Any Minister from any Government has to listen to the facts of the case. He has to operate within certain guidelines. The guidelines are the resources available to the region and the district. The consultation procedure is not a sham.
A balloting system—[Interruption.] I keep my remarks brief, logical and to the point. A balloting procedure is unnecessary because responsibility is being delegated.
We are delegating responsibility for hiring staff, except junior doctors. We must maintain control over the pyramid career structure for all doctors. We must control the number of junior doctors. We want to give NHS trusts the power to hire staff in the numbers and range of qualifications that they need and to pay them the right rate for the job in the local circumstances. That does not mean——

Mrs. Mahon: Will the Minister give way?

Mr. Hoyle: Will the Minister give way?

Mr. Freeman: Certainly I shall give way, but I wish to finish my sentence first. It does not mean that NHS trusts will be able to pay the limit and therefore bid staff away from directly managed units for the simple reason that money is not being printed. NHS trusts will have to win, through contracts, sufficient revenue to balance their books. They will be subject to the same constraints as directly managed hospitals.

Mr. Hoyle: Will the Minister clarify two points? I do not know whether he was in for all the Secretary of State's speech. The Secretary of State said that some unions might be under-represented in the new trust hospitals. If so, will unions be recognised? Secondly, did I understand from the Minister's latter remark that, far from paying the going rate, trusts might pay a lower rate? If so, how will they retain staff?

Mr. Freeman: I was here for the great majority of the Secretary of State's speech although, like many other hon. Members, I sought a brief rest during the night. I heard most of his remarks. He said that there would be no automatic guarantees of union representation in NHS trusts. That would be a matter for the trust. He answered that point fairly and squarely.
The NHS trusts must ensure that they provide a range of services through the contracts that they have won. They must pitch their labour rates for clerical staff and support staff in the hospital at the right level to attract the right number of staff of the right quality.

Mr. Cousins: What is the level?

Mr. Freeman: That is a matter for each NHS trust. The Secretary of State was frank and direct when he said that national pay bargaining and a national structure were not appropriate for NHS trusts. We want the NHS to move to a more flexible system of pay bargaining. My right hon. and learned Friend said of the ambulance dispute that in the future we look to local productivity deals, perhaps arranged regionally at first, so that ambulance men with the right qualifications and approach to work are paid more.

Mrs. Mahon: Does the Minister accept that this modest initiative will affect thousands of Health Service staff? We have the blueprint for what will happen to them, in the confidential Trent document to the general managers for self-governing hospital trusts. It talks about individual remuneration, deskilling, which will lead to even more wards without a skilled person in charge, and separate pay deals. It refers to renegades and subversives when talking about ordinary Health Service workers trying to ensure decent pay and conditions. This is a dramatic change for the staff. Does not the Minister owe it to their dedication and loyalty at least to give them the vote?

Mr. Freeman: My right hon. and learned Friend the Secretary of State made it plain that staff moving to an NHS trust will take their employment contracts with them. The management of NHS trusts may seek in the years after establishement to vary those terms and conditions, like any other concerned, sensible employer. The employer must set the rate for the job that will attract the right quality and quantity of staff.

Mr. Cousins: One paradox is that there may be low pay on the one hand and a high level of pay on the other creating a monopoly of scarce skills in a handful of hospitals. Does the Minister intend that regional health authorities should have the power to arrange the scarce skills in their region so that there is a fair distribution of those skills across the range of hospitals and so that they are not all concentrated in one, two or three hospitals which would therefore hold a monopoly?

Mr. Freeman: I shall deal with the last point first. The hon. Gentleman, who served on the Committee, know

sthat the Secretary of State has powers of intervention in the last resort to prevent any hospital, perhaps an NHS trust hospital, from exercising monopoly powers either in relation to pricing or staffing policy.

Mr. Cousins: An important new point is being made. The Secretary of State made it clear in his speech that the Government are in full intellectual retreat on the issue and that we are to have a highly managed market, if market it be at all. That relates to contracts and pricing. Now the Minister is saying that the wage market will also be highly managed, with all sorts of consequences for the higher arid lower pay ranges. That is an important extra statement that goes beyond anything said in Committee.

Mr. Freeman: I would be the first to recognise, as the whole House does, that in making this major change in the organisation of the NHS, referral patterns, contracts and prices must be managed. Certainly the labour market must be managed. We cannot move overnight to a system of unregulated, unfettered competion. The Secretary of State made that plain. It would not be possible.
The hon. Gentleman asked specifically about those employed in NHS trusts. I said that there was one major exception in the trusts' ability to employ staff in relation to junior doctors. That is an important exception. Although responsibility for determining the numbers and rates of pay of nurses, clerical staff and support staff lies firmly with the NHS trust as the employer, clearly the rates it pays and the number employed are governed by two factors. The first is its own financial resources, because at the beginning of the year a National Health Service trust unit starts with no money in the bank—it is not guaranteed any resources, except the revenue that it earns through various contracts. The second is that it is subject to the market pressures that surround any major enterprise. If it needs administrative and clerical staff, or support workers, it must pay the right rate for the job. That may have a consequence for costs, but it must pay the right rate to attract the necessary staff. The rate of change must be managed, counselled and carefully monitored by the regional health authorities and by the Secretary of State.

Mr. Bill Walker: We have had an interesting response to the hon. Gentleman's point about the effect that this may have on the market. Does my hon. Friend believe—as I certainly do—that in the circumstances a market is working? I shall explain why. Consider the position in my constituency, where the quality of life is good, and we attract high calibre doctors, nurses and other Health Service workers because it is a nice part of the world to live in. It is a good place to bring up children and the education facilities are superb. A market is working and people want to work in my constituency rather than in some of the inner cities, where the pay and conditions are no better. The quality of life in my part of the world is far superior.

Mr. Freeman: I am grateful to my hon. Friend. My argument has been that there will be consultations, but a ballot is unnecessary for the delegation of authority and impractical to organise. I believe that there should be a consensus of support within any potential National Health Service trust. The hon. Member for Manchester, Withington (Mr. Bradley) poured scorn upon that, but it is obvious and important. That initiative will be welcomed


in the National Health Service because it is sound common sense and not dogma, and I urge my hon. Friends to throw out the amendment.

Mr. Renton: rose in his place and claimed to move, That the Question be now put.

Question put, That the Question be now put:—

The House proceeded to a Division—

Mr. Hinchliffe: (seated and covered): On a point of order, Madam Deputy Speaker. [Interruption.]

Madam Deputy Speaker: Order. I am trying to deal with a point of order.

Mr. Hinchliffe: I have sat here all night in an attempt to be called in the debate. This issue is crucial to my constituents. It is disgraceful that we have been forced into a closure motion at this point in time. I hope that you will rule against the Government and defend the rights of Back-Benchers.

Madam Deputy Speaker: Order. If the hon. Gentleman looks at the new clause and examines the comments that have been made in the debate, he will realise that the subject has been fully covered. Additionally, if he looks at the list, he will see how long some hon. Members have spoken—perhaps that is why it has not been possible to call other hon. Members.

Mrs. Mahon: (seated and covered): On a point of order, Madam Deputy Speaker—[Interruption.]

Madam Deputy Speaker: Order. I must hear a point of order.

Mrs. Mahon: A major issue that has not been debated fully during the past 15 or 16 hours has been the effect upon the staff if the new clause is not accepted. The NHS is the largest employer in Europe. It is the duty of the House——

Madam Deputy Speaker: Order. I understand the hon. Lady's feelings, but I am sure that she is not criticising the Chair's decision.

The House having divided. Ayes 259, Noes 136.

Division No. 118]
[10.12 am


AYES


Alexander, Richard
Bonsor, Sir Nicholas


Alison, Rt Hon Michael
Boscawen, Hon Robert


Allason, Rupert
Boswell, Tim


Amess, David
Bottomley, Mrs Virginia


Amos, Alan
Bowden, A (Brighton K'pto'n)


Arbuthnot, James
Bowden, Gerald (Dulwich)


Arnold, Jacques (Gravesham)
Bowis, John


Arnold, Tom (Hazel Grove)
Braine, Rt Hon Sir Bernard


Atkins, Robert
Brazier, Julian


Baker, Rt Hon K. (Mole Valley)
Bright, Graham


Baker, Nicholas (Dorset N)
Brooke, Rt Hon Peter


Baldry, Tony
Brown, Michael (Brigg &amp; Cl't's)


Banks, Robert (Harrogate)
Bruce, Ian (Dorset South)


Batiste, Spencer
Buck, Sir Antony


Beaumont-Dark, Anthony
Burns, Simon


Bellingham, Henry
Butcher, John


Bendall, Vivian
Butler, Chris


Bennett, Nicholas (Pembroke)
Butterfill, John


Benyon, W.
Carlisle, John, (Luton N)


Biffen, Rt Hon John
Carlisle, Kenneth (Lincoln)


Blaker, Rt Hon Sir Peter
Carrington, Matthew





Carttiss, Michael
Irvine, Michael


Cash, William
Jack, Michael


Chalker, Rt Hon Mrs Lynda
Jackson, Robert


Channon, Rt Hon Paul
Janman, Tim


Chapman, Sydney
Johnson Smith, Sir Geoffrey


Churchill, Mr
Jones, Gwilym (Cardiff N)


Clark, Hon Alan (Plym'th S'n)
Jones, Robert B (Herts W)


Clark, Sir W. (Croydon S)
Jopling, Rt Hon Michael


Clarke, Rt Hon K. (Rushcliffe)
Kellett-Bowman, Dame Elaine


Colvin, Michael
Key, Robert


Conway, Derek
Kirkhope, Timothy


Coombs, Anthony (Wyre F'rest)
Knapman, Roger


Coombs, Simon (Swindon)
Knight, Dame Jill (Edgbaston)


Cope, Rt Hon John
Knox, David


Cormack, Patrick
Lamont, Rt Hon Norman


Couchman, James
Lang, Ian


Cran, James
Latham, Michael


Critchley, Julian
Leigh, Edward (Gainsbor'gh)


Currie, Mrs Edwina
Lennox-Boyd, Hon Mark


Curry, David
Lester, Jim (Broxtowe)


Davies, Q. (Stamf'd &amp; Spald'g)
Lightbown, David


Davis, David (Boothferry)
Lilley, Peter


Day, Stephen
Lloyd, Sir Ian (Havant)


Devlin, Tim
Lloyd, Peter (Fareham)


Dickens, Geoffrey
Lord, Michael


Dorrell, Stephen
Luce, Rt Hon Richard


Douglas-Hamilton, Lord James
Lyell, Rt Hon Sir Nicholas


Dover, Den
MacGregor, Rt Hon John


Emery, Sir Peter
MacKay, Andrew (E Berkshire)


Fallon, Michael
Maclean, David


Favell, Tony
McLoughlin, Patrick


Field, Barry (Isle of Wight)
Madel, David


Fishbum, John Dudley
Major, Rt Hon John


Forsyth, Michael (Stirling)
Malins, Humfrey


Forth, Eric
Mans, Keith


Fowler, Rt Hon Sir Norman
Maples, John


Fox, Sir Marcus
Marland, Paul


Franks, Cecil
Marshall, John (Hendon S)


Freeman, Roger
Marshall, Michael (Arundel)


French, Douglas
Maude, Hon Francis


Gale, Roger
Maxwell-Hyslop, Robin


Gardiner, George
Mayhew, Rt Hon Sir Patrick


Garel-Jones, Tristan
Mellor, David


Gill, Christopher
Meyer, Sir Anthony


Glyn, Dr Sir Alan
Mills, Iain


Gorman, Mrs Teresa
Mitchell, Andrew (Gedling)


Gow, Ian
Mitchell, Sir David


Grant, Sir Anthony (CambsSW)
Moate, Roger


Greenway, Harry (Ealing N)
Monro, Sir Hector


Greenway, John (Ryedale)
Montgomery, Sir Fergus


Gregory, Conal
Moore, Rt Hon John


Griffiths, Peter (Portsmouth N)
Moss, Malcolm


Grist, Ian
Neale, Gerrard


Ground, Patrick
Nelson, Anthony


Grylls, Michael
Neubert, Michael


Hague, William
Newton, Rt Hon Tony


Hamilton, Hon Archie (Epsom)
Nicholls, Patrick


Hamilton, Neil (Tatton)
Nicholson, David (Taunton)


Hampson, Dr Keith
Nicholson, Emma (Devon West)


Hanley, Jeremy
Onslow, Rt Hon Cranley


Hannam, John
Oppenheim, Phillip


Harris, David
Paice, James


Haselhurst, Alan
Parkinson, Rt Hon Cecil


Hawkins, Christopher
Patnick, Irvine


Hayes, Jerry
Patten, Rt Hon Chris (Bath)


Hayhoe, Rt Hon Sir Barney
Patten, Rt Hon John


Hayward, Robert
Pawsey, James


Heathcoat-Amory, David
Peacock, Mrs Elizabeth


Hicks, Mrs Maureen (Wolv' NE)
Porter, Barry (Wirral S)


Hicks, Robert (Cornwall SE)
Porter, David (Waveney)


Hind, Kenneth
Price, Sir David


Hogg, Hon Douglas (Gr'th'm)
Raffan, Keith


Holt, Richard
Raison, Rt Hon Timothy


Hordem, Sir Peter
Rathbone, Tim


Howarth, Alan (Strat'd-on-A)
Redwood, John


Howell, Rt Hon David (G'dford)
Ronton, Rt Hon Tim


Howell, Ralph (North Norfolk)
Rhodes James, Robert


Hughes, Robert G. (Harrow W)
Rifkind, Rt Hon Malcolm


Hunt, David (Wirral W)
Roberts, Wyn (Conwy)


Hurd, Rt Hon Douglas
Rossi, Sir Hugh






Rowe, Andrew
Thornton, Malcolm


Rumbold, Mrs Angela
Thurnham, Peter


Ryder, Richard
Townsend, Cyril D. (B'heath)


Sackville, Hon Tom
Tracey, Richard


Sayeed, Jonathan
Tredinnick, David


Scott, Rt Hon Nicholas
Trippier, David


Shaw, Sir Michael (Scarb')
Trotter, Neville


Shephard, Mrs G. (Norfolk SW)
Vaughan, Sir Gerard


Shepherd, Colin (Hereford)
Waddington, Rt Hon David


Sims, Roger
Waldegrave, Rt Hon William


Skeet, Sir Trevor
Walker, Bill (T'side North)


Smith, Sir Dudley (Warwick)
Walker, Rt Hon P. (W'cester)


Smith, Tim (Beaconsfield)
Waller, Gary


Speller, Tony
Ward, John


Spicer, Sir Jim (Dorset W)
Wardle, Charles (Bexhill)


Spicer, Michael (S Worcs)
Watts, John


Stanbrook, Ivor
Wells, Bowen


Stevens, Lewis
Widdecombe, Ann


Stewart, Allan (Eastwood)
Wiggin, Jerry


Stewart, Andy (Sherwood)
Wilshire, David


Stewart, Rt Hon Ian (Herts N)
Wolfson, Mark


Stradling Thomas, Sir John
Wood, Timothy


Summerson, Hugo
Woodcock, Dr. Mike


Taylor, Ian (Esher)
Yeo, Tim


Taylor, John M (Solihull)
Young, Sir George (Acton)


Taylor, Teddy (S'end E)
Younger, Rt Hon George


Temple-Morris, Peter



Thatcher, Rt Hon Margaret
Tellers for the Ayes:


Thompson, D. (Calder Valley)
Mr. Alastair Goodlad and Mr. Tony Durant.


Thompson, Patrick (Norwich N)



Thorne, Neil



NOES


Abbott, Ms Diane
Fields, Terry (L'pool B G'n)


Adams, Allen (Paisley N)
Fisher, Mark


Allen, Graham
Flannery, Martin


Alton, David
Flynn, Paul


Anderson, Donald
Foot, Rt Hon Michael


Armstrong. Hilary
Forsythe, Clifford (Antrim S)


Ashton, Joe
Foster, Derek


Barnes, Harry (Derbyshire NE)
Foulkes, George


Barron, Kevin
Gilbert, Rt Hon Dr John


Battle, John
Griffiths, Win (Bridgend)


Beggs, Roy
Harman, Ms Harriet


Beith, A. J.
Hattersley, Rt Hon Roy


Bennett, A. F. (D'nt'n &amp; R'dish)
Haynes, Frank


Bermingham, Gerald
Henderson, Doug


Blair, Tony
Hinchliffe, David


Boateng, Paul
Hogg, N. (C'nauld &amp; Kilsyth)


Boyes, Roland
Home Robertson, John


Bradley, Keith
Hood, Jimmy


Brown, Gordon (D'mline E)
Howarth, George (Knowsley N)


Brown, Nicholas (Newcastle E)
Howells, Geraint


Buckley, George J.
Howells, Dr. Kim (Pontypridd)


Caborn, Richard
Hoyle, Doug


Campbell, Ron (Blyth Valley)
Hughes, John (Coventry NE)


Campbell-Savours, D. N.
Hughes, Robert (Aberdeen N)


Clark, Dr David (S Shields)
Hughes, Roy (Newport E)


Clarke, Tom (Monklands W)
Hughes, Sean (Knowsley S)


Clwyd, Mrs Ann
Hughes, Simon (Southwark)


Cohen, Harry
Jones, Barry (Alyn &amp; Deeside)


Coleman, Donald
Jones, Martyn (Clwyd S W)


Cook, Robin (Livingston)
Kilfedder, James


Cousins, Jim
Lamond, James


Cox, Tom
Lewis, Terry


Crowther, Stan
Livingstone, Ken


Cryer, Bob
Lloyd, Tony (Stretford)


Cummings, John
McCartney, Ian


Dalyell, Tam
McFall, John


Davies, Rt Hon Denzil (Llanelli)
McLeish, Henry


Davies, Ron (Caerphilly)
McNamara, Kevin


Davis, Terry (B'ham Hodge H'I)
Madden, Max


Dixon, Don
Maginnis, Ken


Douglas, Dick
Mahon, Mrs Alice


Duffy, A. E. P.
Marek, Dr John


Eastham, Ken
Martin, Michael J. (Springburn)


Fatchett, Derek
Martlew, Eric


Faulds, Andrew
Maxton, John


Fearn, Ronald
Meale, Alan


Field, Frank (Birkenhead)
Michael, Alun





Michie, Bill (Sheffield Heeley)
Sheldon, Rt Hon Robert


Molyneaux, Rt Hon James
Skinner, Dennis


Morris, Rt Hon A. (W'shawe)
Smith, Rt Hon J. (Monk'ds E)


Mowlam, Marjorie
Smyth, Rev Martin (Belfast S)


Mullin, Chris
Spearing, Nigel


Murphy, Paul
Steel, Rt Hon Sir David


Nellist, Dave
Straw, Jack


Oakes, Rt Hon Gordon
Taylor, Rt Hon J. D. (S'ford)


O'Brien, William
Taylor, Matthew (Truro)


O'Neill, Martin
Thomas, Dr Dafydd Elis


Orme, Rt Hon Stanley
Thompson, Jack (Wansbeck)


Patchett, Terry
Wardell, Gareth (Gower)


Pike, Peter L.
Welsh, Michael (Doncaster N)


Powell, Ray (Ogmore)
Wigley, Dafydd


Primarolo, Dawn
Williams, Alan W. (Carm'then)


Radice, Giles
Wilson, Brian


Redmond, Martin
Winnick, David


Richardson, Jo
Wise, Mrs Audrey


Robertson, George
Worthington, Tony


Rogers, Allan



Rowlands, Ted
Tellers for the Noes:


Ruddock, Joan
Mr. Allen McKay and Mr. Jimmy Dunnachie.


Sheerman, Barry

Question accordingly agreed to.

Question put accordingly, That the clause be read a Second time:—

The House divided: Ayes 144, Noes 260.

Division No. 119]
[10.24 am


AYES


Abbott, Ms Diane
Field, Frank (Birkenhead)


Adams, Allen (Paisley N)
Fields, Terry (L'pool B G'n)


Allen, Graham
Fisher, Mark


Alton, David
Flannery, Martin


Anderson, Donald
Flynn, Paul


Armstrong, Hilary
Foot, Rt Hon Michael


Ashdown, Rt Hon Paddy
Forsythe, Clifford (Antrim S)


Ashton, Joe
Foster, Derek


Barnes, Harry (Derbyshire NE)
Foulkes, George


Barron, Kevin
George, Bruce


Battle, John
Gilbert, Rt Hon Dr John


Beggs, Roy
Griffiths, Win (Bridgend)


Beith, A. J.
Harman, Ms Harriet


Bennett, A. F. (D'nt'n &amp; R'dish)
Hattersley, Rt Hon Roy


Bermingham, Gerald
Haynes, Frank


Blair, Tony
Henderson, Doug


Boateng, Paul
Hinchliffe, David


Boyes, Roland
Hogg, N. (C'nauld &amp; Kilsyth)


Bradley, Keith
Home Robertson, John


Brown, Gordon (D'mline E)
Hood, Jimmy


Brown, Nicholas (Newcastle E)
Howarth, George (Knowsley N)


Buckley, George J.
Howells, Geraint


Caborn, Richard
Howells, Dr. Kim (Pontypridd)


Campbell, Ron (Blyth Valley)
Hoyle, Doug


Campbell-Savours, D. N.
Hughes, John (Coventry NE)


Clark, Dr David (S Shields)
Hughes, Robert (Aberdeen N)


Clarke, Tom (Monklands W)
Hughes, Roy (Newport E)


Clwyd, Mrs Ann
Hughes, Sean (Knowsley S)


Cohen, Harry
Hughes, Simon (Southwark)


Coleman, Donald
Jones, Barry (Alyn &amp; Deeside)


Cook, Frank (Stockton N)
Jones, Martyn (Clwyd S W)


Cook, Robin (Livingston)
Kilfedder, James


Cousins, Jim
Kirkwood, Archy


Cox, Tom
Lamond, James


Crowther, Stan
Lewis, Terry


Cryer, Bob
Livingstone, Ken


Cummings, John
Lloyd, Tony (Stretford)


Dalyell, Tam
McCartney, Ian


Davies, Rt Hon Denzil (Llanelli)
Macdonald, Calum A.


Davies, Ron (Caerphilly)
McFall, John


Davis, Terry (B'ham Hodge H'I)
McLeish, Henry


Dixon, Don
McNamara, Kevin


Douglas, Dick
Madden, Max


Duffy, A. E. P.
Maginnis, Ken


Eastham, Ken
Mahon, Mrs Alice


Fatchett, Derek
Marek, Dr John


Faulds, Andrew
Martin, Michael J. (Springburn)


Fearn, Ronald
Martlew, Eric






Maxton, John
Sheldon, Rt Hon Robert


Meale, Alan
Shore, Rt Hon Peter


Michael, Alun
Skinner, Dennis


Michie, Bill (Sheffield Heeley)
Smith, C. (Isl'ton &amp; F'bury)


Molyneaux, Rt Hon James
Smith, Rt Hon J. (Monk'ds E)


Morris, Rt Hon A. (W'shawe)
Smith, J. P. (Vale of Glam)


Mowlam, Marjorie
Smyth, Rev Martin (Belfast S)


Mullin, Chris
Spearing, Nigel


Murphy, Paul
Steel, Rt Hon Sir David


Nellist, Dave
Straw, Jack


Oakes, Rt Hon Gordon
Taylor, Matthew (Truro)


O'Brien, William
Thomas, Dr Dafydd Elis


O'Neill, Martin
Thompson, Jack (Wansbeck)


Orme, Rt Hon Stanley
Wardell, Gareth (Gower)


Patchett, Terry
Welsh, Michael (Doncaster N)


Pike, Peter L.
Wigley, Dafydd


Powell, Ray (Ogmore)
Williams, Alan W. (Carm'then)


Primarolo, Dawn
Wilson, Brian


Radice, Giles
Winnick, David


Redmond, Martin
Wise, Mrs Audrey


Richardson, Jo
Worthington, Tony


Robertson, George
Wray, Jimmy


Rogers, Allan



Rowlands, Ted
Tellers for the Ayes:


Ruddock, Joan
Mr. Allen McKay and Mr. Jimmy Dunnachie.


Sheerman, Barry



NOES


Alexander, Richard
Coombs, Simon (Swindon)


Alison, Rt Hon Michael
Cope, Rt Hon John


Allason, Rupert
Cormack, Patrick


Amess, David
Couchman, James


Amos, Alan
Cran, James


Arbuthnot, James
Critchley, Julian


Arnold, Jacques (Gravesham)
Currie, Mrs Edwina


Arnold, Tom (Hazel Grove)
Curry, David


Atkins, Robert
Davies, Q. (Stamf'd &amp; Spald'g)


Baker, Rt Hon K. (Mole Valley)
Davis, David (Boothferry)


Baker, Nicholas (Dorset N)
Day, Stephen


Baldry, Tony
Devlin, Tim


Banks, Robert (Harrogate)
Dickens, Geoffrey


Batiste, Spencer
Dorrell, Stephen


Beaumont-Dark, Anthony
Douglas-Hamilton, Lord James


Bellingham, Henry
Dover, Den


Bendall, Vivian
Emery, Sir Peter


Bennett, Nicholas (Pembroke)
Fallon, Michael


Benyon, W.
Favell, Tony


Biffen, Rt Hon John
Field, Barry (Isle of Wight)


Blaker, Rt Hon Sir Peter
Fishburn, John Dudley


Bonsor, Sir Nicholas
Forsyth, Michael (Stirling)


Boscawen, Hon Robert
Forth, Eric


Boswell, Tim
Fowler, Rt Hon Sir Norman


Bottomley, Mrs Virginia
Fox, Sir Marcus


Bowden, A (Brighton K'pto'n)
Franks, Cecil


Bowden, Gerald (Dulwich)
Freeman, Roger


Bowis, John
French, Douglas


Brazier, Julian
Gale, Roger


Bright, Graham
Gardiner, George


Brooke, Rt Hon Peter
Garel-Jones, Tristan


Brown, Michael (Brigg &amp; Cl't's)
Gill, Christopher


Bruce, Ian (Dorset South)
Glyn, Dr Sir Alan


Buck, Sir Antony
Gorman, Mrs Teresa


Burns, Simon
Gow, Ian


Butcher, John
Grant, Sir Anthony (CambsSW)


Butler, Chris
Greenway, Harry (Ealing N)


Carlisle, John, (Luton N)
Greenway, John (Ryedale)


Carlisle, Kenneth (Lincoln)
Gregory, Conal


Carrington, Matthew
Griffiths, Peter (Portsmouth N)


Carttiss, Michael
Grist, Ian


Cash, William
Ground, Patrick


Chalker, Rt Hon Mrs Lynda
Grylls, Michael


Channon, Rt Hon Paul
Hague, William


Chapman, Sydney
Hamilton, Hon Archie (Epsom)


Churchill, Mr
Hamilton, Neil (Tatton)


Clark, Hon Alan (Plym'th S'n)
Hampson, Dr Keith


Clark, Sir W. (Croydon S)
Hanley, Jeremy


Clarke, Rt Hon K. (Rushcliffe)
Hannam, John


Colvin, Michael
Harris, David


Conway, Derek
Haselhurst, Alan


Coombs, Anthony (Wyre F'rest)
Hawkins, Christopher





Hayes, Jerry
Patten, Rt Hon Chris (Bath)


Hayhoe, Rt Hon Sir Barney
Patten, Rt Hon John


Hayward, Robert
Pawsey, James


Heathcoat-Amory, David
Peacock, Mrs Elizabeth


Hicks, Mrs Maureen (Wolv' NE)
Porter, Barry (Wirral S)


Hicks, Robert (Cornwall SE)
Porter, David (Waveney)


Hind, Kenneth
Price, Sir Deivid


Hogg, Hon Douglas (Gr'th'm)
Raffan, Keith


Holt, Richard
Raison, Rt Hon Timothy


Hordern, Sir Peter
Rathbone, Tim


Howarth, Alan (Strat'd-on-A)
Redwood, John


Howell, Rt Hon David (G'dford)
Renton, Rt Hon Tim


Howell, Ralph (North Norfolk)
Rhodes James, Robert


Hughes, Robert G. (Harrow W)
Rifkind, Rt Hon Malcolm


Hunt, David (Wirral W)
Roberts, Wyn (Conwy)


Hurd, Rt Hon Douglas
Rossi, Sir Hugh


Irvine, Michael
Rowe, Andrew


Jack, Michael
Rumbold, Mrs Angela


Jackson, Robert
Ryder, Richard


Janman, Tim
Sackville, Hon Tom


Jessel, Toby
Sayeed, Jonathan


Johnson Smith, Sir Geoffrey
Scott, Rt Hon Nicholas


Jones, Gwilym (Cardiff N)
Shaw, Sir Michael (Scarb')


Jones, Robert B (Herts W)
Shephard, Mrs G. (Norfolk SW)


Kellett-Bowman, Dame Elaine
Shepherd, Colin (Hereford)


Key, Robert
Sims, Roger


Kirkhope, Timothy
Skeet, Sir Trevor


Knapman, Roger
Smith, Sir Dudley (Warwick)


Knight, Greg (Derby North)
Smith, Tim (Beaconsfield)


Knight, Dame Jill (Edgbaston)
Speller, Tony


Knox, David
Spicer, Sir Jim (Dorset W)


Lamont, Rt Hon Norman
Spicer, Michael (S Worcs)


Lang, Ian
Stanbrook, Ivor


Latham, Michael
Stevens, Lewis


Leigh, Edward (Gainsbor'gh)
Stewart, Allan (Eastwood)


Lennox-Boyd, Hon Mark
Stewart, Andy (Sherwood)


Lester, Jim (Broxtowe)
Stewart, Rt Hon Ian (Herts N)


Lightbown, David
Stradling Thomas, Sir John


Lilley, Peter
Summerson, Hugo


Lloyd, Sir Ian (Havant)
Taylor, Ian (Esher)


Lloyd, Tony (Stratford)
Taylor, John M (Solihull)


Lord, Michael
Taylor, Teddy (S'end E)


Luce, Rt Hon Richard
Temple-Morris, Peter


Lyell, Rt Hon Sir Nicholas
Thatcher, Rt Hon Margaret


MacGregor, Rt Hon John
Thompson, D. (Calder Valley)


MacKay, Andrew (E Berkshire)
Thompson, Patrick (Norwich N)


Maclean, David
Thorne, Neil


McLoughlin, Patrick
Thornton, Malcolm


Madel, David
Thurnham, Peter


Major, Rt Hon John
Townsend, Cyril D. (B'heath)


Malins, Humfrey
Tracey, Richard


Mans, Keith
Tredinnick, David


Maples, John
Trippier, David


Marland, Paul
Trotter, Neville


Marshall, John (Hendon S)
Twinn, Dr Ian


Marshall, Michael (Arundel)
Vaughan, Sir Gerard


Martin, David (Portsmouth S)
Waddington, Rt Hon David


Maude, Hon Francis
Waldegrave, Rt Hon William


Maxwell-Hyslop, Robin
Walker, Bill (T'side North)


Mayhew, Rt Hon Sir Patrick
Walker, Rt Hon P. (W'cester)


Mellor, David
Waller, Gary


Meyer, Sir Anthony
Ward, John


Mills, Iain
Wardle, Charles (Bexhill)


Mitchell, Andrew (Gedling)
Watts, John


Mitchell, Sir David
Wells, Bowen


Moate, Roger
Widdecombe, Ann


Monro, Sir Hector
Wiggin, Jerry


Montgomery, Sir Fergus
Wilkinson, John


Moore, Rt Hon John
Wilshire, David


Neale, Gerrard
Winterton, Nicholas


Nelson, Anthony
Wolfson, Mark


Neubert, Michael
Wood, Timothy


Newton, Rt Hon Tony
Woodcock, Dr. Mike


Nicholls, Patrick
Yeo, Tim


Nicholson, David (Taunton)
Young, Sir George (Acton)


Nicholson, Emma (Devon West)
Younger, Rt Hon George


Onslow, Rt Hon Cranley



Oppenheim, Phillip
Tellers for the Noes:


Paice, James
Mr. Alastair Goodlad and Mr. Tony Durant.


Patnick, Irvine

Question accordingly negatived.

Motion made, and Question proposed, That further consideration of the Bill be now adjourned.—[Mr. Sackville.]

Mr. Robin Cook: The Treasury Whip has moved a motion of which he owes the House an explanation; the House cannot accept it without one. You will confirm, Madam Deputy Speaker, that the motion is debatable. I am surprised that the Treasury Whip should choose to move such a motion at this hour; I could have understood it had he done so last night to save his hon. Friends from a night out of their beds. But now that we have gone throught the night and we are feeling enthusiastic about a day's debate in prime time, an explanation is required. We were just getting into our stride and beginning to enjoy ourselves.
Before the Whip moved the motion, we were about to debate a new clause relating to GPs' lists—[Interruption.] I think that hon. Members are having difficulty hearing——

Madam Deputy Speaker: Order. I have been here a long time but I should still like to be able to hear the debate.

Mr. Cook: As we are debating a procedural motion, it is most important that the occupant of the Chair should be able to hear.
We were about to debate the rights of patients who are in danger of being struck off GPs' lists and to propose to confer on them a right of appeal. That is a matter of considerable interest outside the House, and I know that a number of my hon. Friends have come prepared to speak in the debate. It would be for my hon. Friends' convenience if that debate started now rather than at another time. I cannot believe that it would not also be for the convenience of Ministers. We have two Ministers—three if the Parliamentary Under-Secretary of State is willing to stay—ready and willing to respond to the debate. There is nothing to suggest that it would be for the convenience of either Opposition or Ministers if we adjourned the debate.
You will be aware, Madam Deputy Speaker, that new clause 8 deals with junior doctors' hours. It would be instructive for hon. Members to debate that now, having been out of their beds for a full night. In that debate, we shall challenge the Government's policy, on junior doctors' hours. The Government are prepared to accept as a modest minimal target the one-in-three rota. I need hardly explain to Ministers what that means: every third weekend, junior doctors have to work from 9 am on Friday, right through Saturday and Sunday, until 5 pm on Monday. To put that in the context of the hours that we have been sitting—until the Treasury Whip moved his motion—we have reached only Saturday morning. We should have to continue until midnight on Friday to achieve the same number of hours as Ministers expect junior doctors in hospitals to work on the one-in-three rota.
There is an obvious question here for the House. If Ministers expect junior doctors to work from Friday morning until 5 pm on Monday, why does the Treasury Whip—he has not spoken to the motion but I presume that he will reply to the debate—feel that 10.30 am on the second day of debate is satisfactory? We have another

three days ahead of us to match the doctors. There would be merit in pressing on with the debate, at least until we reached the new clause dealing with junior doctors' hours, so that the House could address that important and serious issue in the same state of fatigue and sleep deprivation in which junior doctors are asked to carry out operations in our hospitals.
Next, we shall come to the new clause on competitive tendering—[Interruption.] For a moment I thought that the Government Whip had deserted us. He should pay attention to the views being expressed——

Mr. Campbell-Savours: My hon. Friend may want to comment on another aspect of this motion. The Government were defeated last night, and the public are entitled to ask whether we are being required to truncate debate on the Bill because the Government cannot afford another defeat. If Conservative Members feel after many hours of debate that the Opposition have a case, the Government may think it best to truncate debate as much as possible so as not to allow the opportunity for another defeat. That is a serious proposition.

Mr. Cook: My hon. Friend raises an intriguing matter. Perhaps the Government Whip does not have enough troops to deliver the motion this morning. After all, so far the Government have won only five out of the six votes, and given their majority that is a poor record. It is open to the House, therefore, in the non-partisan spirit in which we debated new clause 1, to examine this motion, which the Government have yet to defend.

Mr. Jeremy Hanley: Perhaps the truncation of business has more to do with the fact that the hon. Gentleman spoke for one hour and 48 minutes earlier this morning than with any risk of the Government losing future votes.

Mr. Cook: The hon. Gentleman reminds me of my previous record, which I clearly have to beat on this occasion. The hon. Gentleman fairly states that I spoke for one hour and 48 minutes, and suggests that that is the reason for the remarkably brief speech made now by the Treasury Whip.
The Secretary of State for Health spoke for one hour and 10 minutes. I seek the hon. Gentleman's guidance: where, between one hour and 10 minutes and one hour and 48 minutes, rests the optimum time appropriate to the dignity of a Front-Bench speaker?

Rev. Martin Smyth: Will the hon. Gentleman sympathise with Members who represent Northern Ireland, who do not have the luxury of exploring the changes in our Health Service in the same depth? In the coming months those changes will be foisted on us after only five hours of debate, so we appreciate the depth of investigation that is going on in the House now.

Mr. Cook: I have noted that the Northern Ireland Bench has frequently been full during our debates and I hope that we have given Northern Ireland Members plenty of ammunition.

Mr. Bermingham: Will my hon. Friend consider the fact that, as he spoke for one hour and 48 minutes and the Treasury Whip replied in a moment, if he had spoken for three or four hours, we might not have heard from the Whip at all?

Mr. Cook: Eventually, even my own party—

Mr. Hanley: The Secretary of State, with his usual courtesy, spoke for one hour and 10 minutes to answer the thousands of points made by the hon. Gentleman during his filibuster.

Mr. Cook: The hon. Gentleman rather overstates the case: I would not claim to have made thousands of points during my speech, although I am flattered at the hon. Gentleman's suggestion. I made several dozen points and, patently, since you, Mr. Deputy Speaker, allowed me to make them and thought it appropriate for the Secretary of State to respond to them, they must have been in order and relevant to consideration of the Bill. So the hon. Gentleman has condemned himself from his own mouth. I and my hon. Friends want to scrutinise an enormous number of points in the Bill, which is why we were taken aback that the Government Whip thought this an appropriate moment to curtail debate——

Mr. Bill Michie: Are not the Government rubbing salt in the wound? Some of us have been here all night, myself included—apart from two hours that I spent outside the Chamber. Not only was I prevented from making a speech on new clause 4, but the Government are curtailing further discussion of the Bill. That is precisely what the Government have been doing with the Health Service in general. It is the people's service, not the Government's. The Government dictate what will happen to the service, and then consult. The Government are suggesting that we all go home because they have lost the argument.

Mr. Cook: They also lost the vote, as my hon. Friend will recall.

Mr. Frank Haynes: We are not running away. I thank my hon. Friend for giving me the opportunity to make an intervention. I want him to know that I saw the Secretary of State for Health not long ago, and he is in a terrible state. His problem is that he cannot stand the pace. The Government want to shut down debate so that he can go to bed, and he looks as though he needs to. We, however, are fit as fiddles—and I have been here all night, too. I am raring to go.
The Tory Benches are empty; Conservative Members all want to knock off and get to bed. I recognise that the hon. Member for Richmond and Barnes (Mr. Hanley) has been here all night, too. I was a little surprised that he objected to the length of my hon. Friend's speech. It was a brilliant speech. The hon. Member for Richmond and Barnes had the chance to match it, but he did not. Now he should object to the motion to close the debate, so that he can make that speech. I want to make a speech, too, which is why I object to the motion.

Mr. Cook: I think that I can assist my hon. Friend. If the purpose of the motion is to allow the Secretary of State to go to bed, I immediately offer the Whip an agreement; it is the only agreement that I shall offer him during these proceedings. I am perfectly content that the Secretary of State should go to bed while the rest of us carry on with the Bill. In the light of experience of his presence, I assure the Government Whip that we shall make more rapid progress in the absence of the right hon. and learned Gentleman. If that is the point of the motion, we can accommodate it

without sacrifice. It is not we who are running out; it is the Treasury Whip who wants to run out of the debate and away from the Chamber——

Mrs. Mahon: Will my hon. Friend give way?

Mr. Cook: I shall give way to my hon. Friend, who has been with me through the dark hours of the night.

Mrs. Mahon: Does my hon. Friend agree that it could be that Conservative Members do not want to debate new clause 9, known as the "Forsyth" clause? Twenty Conservative Members have an interest in private contractors and the debate could be embarrassing to them. As we beat them during the night, perhaps a sense of conscience would break out, they would declare an interest and refuse to vote.

Mr. Cook: That new clause is yet another one which would be postponed as a result of the motion moved by the Treasury Whip. My hon. Friend the Member for Halifax (Mrs. Mahon) puts an angle on new clause 9 that had not occurred to me. It is certainly true that we have drafted that new clause in such a way as to oblige firms that obtain contracts from the Health Service to declare those parliamentary consultancies that they have awarded in the previous six years. Undoubtedly that would result in the name of at least one Health Service Minister appearing on that register as someone who has held such a consultancy in the past six years.

Mr. Neil Hamilton: What about union sponsorship?

Mr. Cook: Our sponsorship is openly recorded and all that we ask is that consultancies held by Conservative Members and Health Ministers are equally openly recorded.
If we did not accept the motion from the Treasury Whip, it would be possible, given the current rate of progress, to reach the debate on new clause 9 before the newspapers for tomorrow have gone to bed. By postponing the debate further, the Government may try to smuggle that debate through at an hour when it would not attract the media attention it otherwise would at prime time.

Mr. Skinner: My hon. Friend is making a good case, but we all know that a guillotine will follow. This is an ill wind that blows no good for anyone. If the Government stop the debate this morning they will finish up with the Secretary of State for Trade and Industry having to answer questions on uncomfortable issues such as Harrods, the invisibles being invisible and the rest of it. My hon. Friend mentioned some of the Tory Members who are involved in murky dealings with private companies. Could he spare a moment to read out that list of Tory Members—I believe that about 30 of them have got their fingers in the pie? My hon. Friend has access to that information.

Mr. Deputy Speaker (Sir Paul Dean): Order. Before the hon. Member for Livingston (Mr. Cook) responds to that invitation, he should remember that we are dealing with the motion, That further consideration of the Bill be now adjourned.

Mr. Cook: I respond, of course, to your instruction, Mr. Deputy Speaker. The list is here, but we can arrange


to deposit it in the Library, provided that the Library does not follow its recent practice of posting the information back to the hon. Members concerned.
My hon. Friendthe Member for Bolsover (Mr. Skinner) raised a consideration that crossed my mind during the latter half of the Secretary of State's speech. I wondered whether the concealed purpose of the right hon. and learned Gentleman's speech was to filibuster out Trade and Industry question time under instructions from the Cabinet. What my hon. Friend the Member for Bolsover said about a guillotine being contemplated is rather sinister. We heard nothing about that from the Treasury Whip. We merely heard an innocent and apparently innocuous notion that would have the simple effect of postponing our debate for five hours.

Mr. Cryer: If a guillotine follows, that will be relevant to the business interests of Tory Members involved in the Health Service. Rumours are flying that a guillotine will follow and it is said that the Government have moved to adjourn progress ready to introduce a guillotine. That will curtail discussion greatly and would be to the advantage of hon. Members who see privatisation as a great opportunity for the enterprise culture, as opposed to Opposition Members who have tabled clauses and amendments to try to retain public ownership of the National Health Service. I suggest to my hon. Friend that the business interests of Tory Members are relevant to the debate.

Mr. Cook: My hon. Friend tempts me, but I shall be guided by your advice, Mr. Deputy Speaker, and——

Mr. Campbell-Savours: rose——

Mr. Cook: I cannot resist giving way to my hon. Friend on this point.

Mr. Campbell-Savours: If it is the Government's intention to curtail debate on new clause 9, and our efforts today to draw the public's attention to the relationship between Conservative Members and private contractors are curtailed, we shall bring Parliament to a halt. The public need to know what is going on in that sleazy relationship. If our debate is curtailed in any way we shall bring this place to a halt.

Mr. Cook: I have spent some time out of the Chamber—not much—in the past few hours and, having watched television and heard the radio, I assure my hon. Friend that the world outside now knows of the vigorous opposition being presented to this deeply unpopular Bill. In the current opinion polls the Bill is even more unpopular than the poll tax Bill was at the same stage of its parliamentary proceedings last year.

Mr. Nigel Spearing: On a point of order, Mr. Deputy Speaker. I wonder whether you can assist me. The question is whether we should proceed with the debate and have further discussion on the substance of the Bill. My hon. Friend the Member for Bolsover (Mr. Skinner) suggested that there may be less time for such discussion in the near future if a guillotine or timetable motion is moved. We are not sure whether that will happen. If no timetable motion was planned, I would take a different view of the motion before us. Can you tell us, Mr. Deputy Speaker, whether there is any way in which Ministers can inform the House whether a timetable motion is envisaged

—I am not asking about its details, but about the principle. Unless we know whether that is likely, we cannot properly debate the merits of the motion.

Mr. Deputy Speaker: The hon. Gentleman and the House will know that that is hypothetical. In any event. it has nothing to do with the Chair.

Mr. Madden: Further to that point of order, Mr. Deputy Speaker. About 17 hours ago my hon. Friend the Member for Workington (Mr. Campbell-Savours) and I asked Mr. Speaker whether it was proper for Conservative Members with direct pecuniary interests in private contracting companies and other interests directly related to the Bill to vote. Mr. Speaker explained that, as a matter of public policy, such voting was permissible. Is it right for such hon. Members with direct pecuniary interests to vote on procedural motions that would have the effect of gagging the House on new clause 9? That new clause specifically concerns Tory Members with direct pecuniary interests in the NHS, and it is clearly connected with the health trusts that are an integral part of the Bill.
I should be grateful if you reflected on this and gave hon. Members advice on whether it is proper for such Tory Members to vote on procedural motions, because, when such motions are considered, they have no opportunity to declare their interests. It could be held that those hon. Members are putting themselves in considerable difficulty and embarrassment if, subsequently, they are found to have voted on procedural motions that had the effect of gagging the House in relation to their interests.

Several Hon. Members: rose——

Mr. Deputy Speaker: Order. Let me deal with this point. I heard Mr. Speaker's ruling at the beginning of our debates and exactly the same ruling applies to the procedural motions.

Mr. Cryer: Further to that point of order, Mr. Deputy Speaker. I must draw your attention to what happened regarding the private Bill on Lloyd's in 1981, when the position was again slightly obscure. Speaker Thomas simply said that any hon. Member who might have a clash of interests in relation to a private Bill promoted by Lloyd's should refrain from voting. There were 70 members of Lloyd's present during the various stages of that Bill and all except one abstained from voting, on the general guidance of Mr. Speaker.
Some of the Members of Parliament who have a financial interest in the matter receive money from public relations organisations which advise cleaning companies, private medical organisations and so on. Others receive direct payments—for example, from Brent Green Cleaning Services, which is involved in National Health Service contracts.
It seems to me that it would be worth while for you, Mr. Deputy Speaker, to refer that point to Mr. Speaker, so that he may re-examine the question and determine whether the 1981 example set by the Lloyd's Bill is definitive. If so, M r. Speaker can then tell right hon. and hon. Members, "If you have any direct pecuniary interest, you know best"—we know that many Conservative Members are not very keen about disclosing their interests—"but I advise you that the best decision would be to abstain."

11 am

Mr. Deputy Speaker: Mr. Speaker dealt also with that point at the start of the debate, when he drew a clear distinction between private Bills and public Bills. There is nothing that I can add, or need to add, to Mr. Speaker's ruling. I remind the House that the speech of the hon. Member for Livingston (Mr. Cook) has been interrupted, and I am anxious that we should return to it.

Mr. Campbell-Savours: On a point of order, Mr. Deputy Speaker.

Mr. Deputy Speaker: Order. I have dealt with the point that was raised. If the hon. Member for Workington (Mr. Campbell-Savours) has a different point of order, I shall take it—but I remind him that he will be further delaying the speech of his hon. Friend.

Mr. Campbell-Savours: You, Mr. Deputy Speaker, ruled on the basis of a ruling that was made at the beginning of the debate by Mr. Speaker. I accept that that was the basis of your ruling, but we are now raising a completely different matter. It does not relate to public policy issues, to which Mr. Speaker's earlier ruling related.

Mr. Deputy Speaker: Order. I have already dealt with that matter, and I have said that the same applies in both cases.

Mr. Campbell-Savours: Further to that point of order, Mr. Deputy Speaker. Perhaps you would care to examine the text of "Erskine May" while I am on my feet. Although your ruling is acceptable in relation to public policy issues, the question now before the House is one of procedure. We are not drawing a distinction between a private Bill and a public Bill but are debating a procedural motion.

Mr. Deputy Speaker: I take the hon. Gentleman's point. The appropriate reference appears on page 357 of "Erskine May":
Procedural Motions: no interest involved.
As no financial interest is involved in procedural motions such as closures, Members have been allowed to vote for the closure on bills in which they may have a financial interest.
The motion now before the House is a procedural one, and that guidance in "Erskine May" is clear.

Mr. Cryer: On a point of order, Mr. Deputy Speaker. I understand that a business statement is to be made later today, at the conclusion of this debate on progress. There is no indication on the annunciator that a business statement is being prepared by the Government. However, I understand that they have woken up the Leader of the House to come here to make a business statement. Will you, Mr. Deputy Speaker, ensure that any announcement of a business statement is properly made, well before the statement itself, so that right hon. and hon. Members will know to come to the Chamber to ask questions on it?

Mr. Deputy Speaker: The matter of business statements is not for the Chair, but I am sure that the hon. Gentleman's point has been heard on the Treasury Bench.

Mr. Robin Cook: Although I do not wish to raise the matter as a point of order, Mr. Deputy Speaker, I was interested by your last point. If there is to be a business statement, I should have thought that, as a matter of courtesy to Mr. Speaker, the Speaker's Office would by now have been advised of that fact.
I now find myself in some difficulty, in that, since I last resumed my seat, the Treasury Whip who moved the motion has departed. The Treasury Whip now present in the Chamber is not the Whip who originally moved the motion, and was not in the Chamber at the time—

Mr. Michael Fallon: indicated dissent.

Mr. Cook: The hon. Gentleman indicates that he was present. I am perfectly willing for him to intervene if he wishes to clarify the point, because I am interested to know whether he intends to proceed with the motion, given that the Whip who moved it has now departed from the Chamber. When I saw the Whip who moved the motion departing, I had a moment of hope that, having been made aware of the strong views of right hon. and hon. Members an of the Opposition's clearly stated desire to proceed with the debate—for there is no advantage to us in adjourning the House at this stage—he had decided not to pursue the closure.
As to new clause 9 and competitive tendering, one of the points that we wish to examine is the remarkable casualisation of the hours that goes with competitive tendering, and the frequently deeply unsocial hours that are associated with private contractors, who have no regard to retaining—[Interruption.] I shall give way to the hon. Member for Tatton (Mr. Hamilton) if he wishes to intervene—but if he does not, I shall be obliged if he will not keep up a constant monologue during my speech.

Mr. Neil Hamilton: It is a bit rich of the hon. Member for Livingston (Mr. Cook) to complain about unsocial hours when his filibustering caused us to be here all night.

Mr. Battle: But the hon. Gentleman was paired out.

Mr. Cook: I am grateful for my hon. Friend's clarification. Perhaps someone can produce a Division List to show that the hon. Member for Tatton has shared the unsocial hours that have certainly been shared by my right hon. and hon. Friends.

Mr. Leigh: When I was voting at a quarter to five this morning, only about 55 Labour Members were present to vote. Were all the others in bed? What is this talk of Opposition Members staying up all night?

Mr. Cook: With respect, the matter was raised by the hon. Member for Tatton. My right hon. and hon. Friends run a relaxed, liberal and free whipping system. I am bound to say that it seems to be more successful than the whipping system run by Conservative Members. Those of my right hon. and hon. Friends who had to address their minds to other important matters were given full permission earlier this morning to leave. It is a matter of regret that Conservative Members were obliged to remain when they wished to go home to their beds. We would be willing to support their representations to the Treasury Whip that they should enjoy the same rights and prerogatives granted to my right hon. and hon. Friends and myself, and should be free to come and go as their stamina allows.
I am somewhat disturbed by the lack of stamina in the new Conservative parliamentary party. When I first entered the House, I was appointed to the Committee considering the Community Land Bill, which undertook five all-night sittings in two weeks. That was due to no filibustering on the part of my hon. Friends or myself but was entirely the result of the length of speeches made by


the then Conservative Opposition. One of the older Conservative Members, observing a couple of my hon. Friends asleep at six in the morning, remarked that the trouble with the Labour party was that it was full of people who had wasted their youth receiving an education at grammar school and university, whereas he had spent his youth constructively, spending whole nights at nightclubs—and therefore was better fitted for the rigours of parliamentary life. I am sorry that there seems to be something of a declension in the stamina, fitness, and possibly background of the members of the modern Conservative parliamentary party.

Mr. McCartney: I wish to make a more serious point. Those of us who were involved in the debate on clause I on community care and other matters which carried on throughout the night included members of the Select Committee who are most concerned about the curtailment of the debate. The second part of the Bill relates to ring fencing, and we are concerned about the ability of the House to determine the proper and appropriate funding for care in the community.
We know that the Government resisted proposals from the Select Committee and from both sides of the House. One of their reasons for wishing to curtail the debate later this afternoon may be to prevent further discussion on ring fencing care in the community. That would be a disaster for the House and for the elderly and for those with physical and mental handicaps who will be left without the resources to implement the proposals of the Griffiths report. I hope, that having had the knockabout, we will get down to the serious business of nailing the Government to the mast about the lack of resources to implement the proposals about care in the community.

Mr. Cook: My hon. Friend justly reproves me. We are considering matters of the greatest gravity and seriousness.
My hon. Friend referred to the clauses on community care. He is absolutely right that those clauses are at the end of the Bill. It has always been my suspicion that they were put at the end of the Bill in the expectation that they would be forgotten. That is why, when my hon. Friend and I met in Committee to discuss our strategy, we decided on a timetable that from the start was deliberately devised not to give the Secretary of State the protection and satisfaction of a guillotine that would rob us of any debate on the clauses at the end of the Bill, but to agree on a pace of proceedings in that Committee that would enable us to ensure that those clauses were adequately examined and scrutinised. I take pride in the fact that my hon. Friends and I were able to devote four full days to examining those important clauses on community care.
Since the Secretary of State has returned to the Chamber, I must say that he was fully privy to the discussions that resulted in that timetable and those four days being set apart for the clauses. I regard as a breach of faith on his part the way in which, ever since, he has misrepresented that agreement and that strategy as an absence of opposition to his measure and an acceptance of the major proposals in his Bill.
I am happy to share it with the House, as the Secretary of State is now present, that I regard that breach of faith, that misrepresentation in public of our strategy in Committee and the downright deceitful things that have been said about behaviour in Committee as well beyond the acceptable behaviour between Opposition Front

Bench and the Government. As long as the Secretary of State holds offices of the Crown, he will never again get an agreement from me for any legislation that he brings to the House because he is not a man who can be trusted with any agreement.

Mr. Kenneth Clarke: I admire the way in which the hon. Gentleman can turn from feigned frivolity to feigned pomposity and sensitivity as he appears to be wounded by my description, which remains my candid opinion of his performance in Committee and the quality of the arguments that he produced. I am entitled to that opinion and I shall retain it.
As for the important clauses to which the hon. Member for Makerfield (Mr. McCartney) referred, they come quite early in the selection, which I accept is because of the order in which the new clauses were tabled for Report by the hon. Gentleman. But during the past 18 hours or so, we have heard exactly the same arguments as we heard in Committee, but made at three times the length by the hon. Gentlemen who put them in Committee. If we had made the same progress as we made in Committee, we would have had a debate on new clause 36 long before now. Frankly, the larking about of Opposition Members has prevented the hon. Member for Makerfield from having a debate on ringfencing during today's proceedings.

Mr. Flannery: On a point of order, Mr. Deputy Speaker. The Secretary of State is abusing the House. Many of us spend a great deal of our lives on Committees and we cannot all be on the same one at the same time. He is saying that those of us who were not on the Committee have no right to debate the subject and that those of us who were on the Committee have debated it too much already and therefore there should not have been arty debate at all.

Mr. Deputy Speaker: It would be better if we got on with the debate.

Mr. Cook: I wish to respond to the Secretary of State's intervention. He made an observation that the House might wish to ponder. He said that, if we had made the same progress on Report as we made in Committee, we would have reached new clause 36 by now. Perhaps the Secretary of State should reflect on the fact that, ever since the Committee was reaching a conclusion, he has used the progress made in Committee as evidence in his contention of a lack of opposition to the Bill and an acceptance of its fundamental principles. If he says that about the progress that was achieved in Committee, he should hardly expect that progress to be replicated on Report.

Mr. McCartney: There is a fundamental and important issue at stake here. Since the Committee met, the non-partisan Social Services Select Committee, which has a Conservative majority, has produced two substantive reports, one in particular about ring fencing and appropriate recommendations for the House to consider. The amendments on the Order Paper were tabled not in the name of my hon. Friend the Member for Livingston, (Mr. Cook) but in the names of hon. Members who prepared that report for the Select Committee.
If, under the guillotine motion, the Secretary of Stale does not give adequate consideration to the amendments in the name of my hon. Friend, he must at least give a


commitment to ensure that there will be time to consider the amendments and recommendations proposed by the Select Committee. If he does not do that, there will be no further consideration of resources in the community for those who are most vulnerable. He should give that commitment to the House in a non-parisan way.

Mr. Cook: My hon. Friend perfectly refutes one of the Secretary of State's contentions—that he has merely heard the debate that he heard in Committee.
I invite the Secretary of State and the House to reflect on our debate on new clause 1. Some of the principles of new clause 1 were certainly aired in Committee, but there was much new material, never mind new hon. Members joining in that debate on Report. An important part of that new material was the Select Committee report to which my hon. Friend referred, because it was not available to us when we met in Committee. We have not been provided with that evidence of all-party agreement among hon. Members who considered the matter in depth, examined witnesses, taken evidence and reached the conclusion that matters were insupportable. It may be that that new evidence was part of the reason why, last night, the Government suffered their first defeat since 1987.
My hon. Friend referred to ring fencing. The Secretary of State is entitled to say, and no doubt will say, that we debated ring fencing in Committee. I spoke for half an hour in that debate about ring fencing. Perhaps the Secretary of State should decide whether that constitutes feeble and token opposition or whether it constitutes a filibuster. Perhaps the hon. Member for Tatton and the Secretary of State would like to put their heads together and work out which option to choose on this occasion. It is certainly the case that, in Committee, we did not have the Select Committee report which was published on Monday and which shows the very strong all-party feeling for ring fencing.
My hon. Friend is correct to say that new clauses 36, 37 and 73 and amendments tabled in my name also deal with that issue. They are important matters for the House to debate, partly because they refer to carers who provide care and attention for elderly people who require constant nursing, with minimal domiciliary support and very little opportunity for respite care. The Bill contains no proposals to widen that respite care.
Carers who look after relatives who are in need of constant nursing do not have the option of a Treasury Whip moving that they adjourn their caring until the next day. They must provide constant, 24-hour caring, frequently with interruption of sleep. It would be appropriate, in the interests of those who serve our society selflessly and at great cost to their health, for us to continue with our proceedings until we reach new clause 36.

Mr. McCartney: Is my hon. Friend aware that there have been further developments since the proceedings in Committee? For example, we have had the report of the Select Committee. Further, we have yet to hear more about the Government's funding of the poll tax in England and Wales and the possibility of the Government capping certain authorities. That could have a fundamental effect on the funding of some provisions in the Bill. Does my

hon. Friend agree that the Secretary of State must make it clear how those recent occurrences are likely to affect the funding of the Bill?

Mr. Cook: My hon. Friend again produces important new material which has emerged since we debated the Bill in Committee. My hon. Friends who were with me in Committee will recall that, when we debated ring fencing, I drew attention to the extent to which the Government's standard spending assessment had assumed that social services authorities in England would be spending this year £200 million less in real terms than they spent last year. That cannot be reconciled with the claim that the Bill will expand community care. Implicit in the Government's standard spending assessments is a reduction in social service spending, and therefore in community care.
My hon. Friend the Member for Makerfield (Mr. McCartney) draws attention to the fact that, since we debated that issue in Committee some weeks ago, the whole debate about the community charge has undergone a sea change. We now know that the community charges are at a level never anticipated by Conservative Members and that any increase to meet the shortfall in standing spending assessments would be unsupportable. We also know from the increasing panic on the Government Benches that some local authorities will be poll tax-capped, and that in turn will have devastating effects on the quality of social services in those authorities.
I must, in that sense, rebuke the Secretary of State because those are two new matters which the House must consider. Those new issues emphasise the importance of our making progress with the Bill and reaching new clause 36, but I fear that the Treasury Whip is seeking to frustrate that debate.

Mr. Kenneth Clarke: For all his flannelling about, the hon. Gentleman cannot get away from the fact that his change of tactics has put in jeopardy the debate which his hon. Friend the Member for Makerfield (Mr. McCartney) wants to have. The hon. Member for Livingston (Mr. Cook) was faced with a dilemma in Committee. Had he filibustered the Standing Committee, he ran the risk of a guillotine, which in turn ran the risk of excluding debate on care in the community. He decided to enter into an agreement and debate care in the community.
In an earlier speech I paid tribute to the fact that we debated the whole Bill at that stage. We had an agreement, to which we kept. I will always keep to agreements that I make, as will my hon. Friend the Member for Derby, North (Mr. Knight). Part of that agreement was that Report and Third Reading would be handled in two and a half days, which was a concession that we made as part of that agreement.
Since then, Opposition Members have had a change of mind. They turned up last night—today, in parliamentary terms—setting out on a vain and obvious filibuster once we got past the serious debate on new clause 1. The hon. Member for Livingston is now talking, apparently with no limit, on a procedural motion because he has suddenly realised that the whole night has gone by with him and his hon. Friends rehearsing at enormous length arguments that we had all heard before. His hon. Friend the Member for Makerfield appreciates that the time last night should have been used seriously to discuss such matters as care in the community.

Mr. Cook: I am always happy to give way to the Secretary of State, because it is interesting to analyse his comments. He has now been more balanced and honest than at any time in the last two months about what happened in Committee. He has faced up to the fact that we had to decide that if we went for the guillotine in Committee, the clauses on care in the community would not have been adequately debated. We chose a timetable which provided for far more rigorous scrutiny of those clauses than would have come out of any guillotine motion that the right hon. and learned Gentleman might have proposed. Out of those debates came the genesis of our earlier debate on new clause 1.
That is not what the Secretary of State has been saying in recent weeks. I have with me some comments that he has made, particularly on radio. He said that the Bill was making
smooth and rapid progress through Committee.
He said:
It has not given rise to any sensational parliamentary controversy.

Mr. Campbell-Savours: What about Michael Forsyth?

Mr. Cook: It gave rise to the only suspension of a Standing Committee in this Parliament, and it has given rise to the first defeat of the Government. I would not describe that as no sensational parliamentary controversy.
The Secretary of State proceeded to elaborate on that smooth and rapid alleged progress and alleged lack of sensational parliamentary controversy when he said:
I seriously believe that the Labour and Liberal parties privately accept the need for most of the reforms that we are proposing.
If we have done one thing in the last 24 hours, I hope we have disabused the Secretary of State of the notion that his vile, irrelevant and damaging Bill is not opposed by the Opposition.

Mr. McCartney: Parliamentary procedures debar me from saying that the Secretary of State tells lies. I will only say that his nose is larger than Pinnochio's. The position is clear. At all times the Government control the timing and nature of our debates. If the Secretary of State is as concerned as we are to discuss community care, will he give an absolute commitment that the Government business managers, in preparing the guillotine motion that will surely come, will ensure that ample opportunity is provided to debate the clauses relating to community care and ring fencing, remembering that those issues were the subject of a Select Committee Report published on Monday?

Mr. Cook: I hear my hon. Friend's observations. His concern for those issues was reflected in our priorities in Committee and in choosing new clause 1 for debate at this stage of the Bill. I draw attention to the fact that, after we have disposed of new clause 36 and other new clauses, the first amendment to which we shall come relates to the appointment of chairs of health authorities.

Mr. Bermingham: Is my hon. Friend aware that, in my constituency, a former major mental hospital is being closed down? We do not have the facilities to house those who are being discharged into the community and who are finding their way to Liverpool and north Wales and are living in cardboard boxes. We are also faced with the problem of probable capping for poll tax. Those and other problems that we face must be aired. The difficulties to

which my hon. Friend the Member for Makerfield (Mr. McCartney) referred, and which were highlighted by the Social Services Select Committee, are the real problems concerning care in the community. They must be debated and solved before human beings are cast on to the streets with nowhere to go.

Mr. Cook: Our debate of new clause 1, the longest debate we have had in these proceedings, was marked by exactly that type of concern for our constituents. The human dilemma that is faced throughout the country was raised in speeches by hon. Members on both sides. Thai is why I take it amiss when the Secretary of State accuses us of having spent the past 18 hours merely rehearsing partisan arguments.

Ms. Diane Abbott: Does my hon. friend agree that it is extraordinary for the Secretary of State to accuse those who took part in the debate on new clause 1 of mere filibustering? He should remember some of the many considered, constructive and heartfelt contributions from Conservative Members. Is he smearing them with his accusations of filibustering? [Interruption.]

Mr. Cook: The Secretary of State appears to have changed his mind.

Mr. Kenneth Clarke: rose——

Mr. Cook: I am happy to give way to the Secretary of State, but he accused the House of filibustering. Our debate on new clause 1 was the longest that we had during this sitting.

Mr. Clarke: I am sure that I said that, after we finished the first debate on new clause 1, we started to filibuster—[Interruption.] Yes, I did. It is no good the Opposition, having realised that they have made a complete pig's ear of their tactics on the Bill, suddenly becoming abusive, as they are beginning to do. We had an agreement on a timetable in Committee which seemed sensible to both sides of the House, which we kept. Part of the agreement was that we should spend two days on Report and half a day on Third Reading.
The hon. Member for Livingston (Mr. Cook) obviously began reading his press cuttings and was wounded because I described the Committee stage as having gone smoothly and to a good timetable. I know that, behind his robust exterior, the hon. Gentleman is more sensitive than he seems. However, the fact is that we went smoothly and made good progress in Committee. He may have had excellent motives for allowing us to do so.
In the middle of last night, when we finished new clause 1, the Opposition, to show machismo about the issue, suddenly began to give great long speeches about things that we had heard before. We have now reached the stage when we are reporting progress, having made little progress on the list of amendments. The hon. Members for St. Helens, North (Mr. Bermingham) and for Makerfield (Mr. McCartney) and other hon. Members with a genuine concern about care in the community and many other aspects of the Bill, are quite right to complain that we have had a pretty unsatisfactory few hours through the night to this stage. That is because the hon. Member for


Livingston, having followed one course in Committee, because of some press cuttings, had a total change of mind and ran last night in a quite different fashion.

Mr. Cook: The Secretary of State misses the point. The problem is not that the Secretary of State said that the Bill was making smooth and rapid progress in Committee; the problem which he has not disposed of is that he then built on that the assertion that the Labour party did not oppose the Bill. That assumption is wholly without foundation.
There was an even more interesting point in the Secretary of State's intervention, and again he fills a useful Socratic role. In a single sentence, he encapsulated much better than I have yet managed to do the case against the motion from the Treasury Whip. We have got through our third successive Treasury Whip since we began debating this motion. No wonder the Whips want to adjourn and go away; they can last only half an hour at a time on the Bench.
The Secretary of State said that we were reporting progress when there is little progress to report. One could not think of a better argument against reporting progress. If there is little progress to report, why are we reporting progress? What progress are we reporting? Would not it be far better in these circumstances to seek to make more progress before we report progress?
Before my hon. Friend the Member for St. Helens, South (Mr. Bermingham) intervened, I was about to say that, when we make progress in defiance of the Treasury Whips, reach clause 1 and consider the first group of amendments to that clause, we shall be considering amendments relating to the appointment of chairs of district health authorities. There is an important reason why the House may wish to debate that matter, and debate it now.
On Friday, the Secretary of State released the full slate of virtually every chair of the district health authorities in England. I arranged my Friday around the expectation of that statement. I stayed in London to receive the list of new names. I was anxious to receive this additional information and to see the kind of person and the background of the people who had been appointed as chairs of district health authorities.
When I received the press release at 3.30 pm on Friday, I found that it was literally a list of names with initials. It did not even give christian names, just surnames and initials. There was no designation, no background, no address, no qualifications and no nominations. I have never seen a press release that had been so thoroughly passed through the wringer to squeeze out of it all useful and helpful information. Why had that been done? Because the Secretary of State did not wish us to finger the reasons why those people had been appointed.
The Secretary of State's ruse did not entirely work. We were able to piece together quite a few pieces of information. We were able to work out that, of the seven known Labour party members who are chairs of health authorities in England, three were sacked last Friday. That is an important matter to which the Opposition wish to address their minds. We find it convenient to do so today. We would rather address our minds to it as soon as possible after the event than postpone it to a future day.
The other matter that we would wish to consider when we debate that list and the partisan way in which Labour

figures have been discriminated against, is the even more remarkable way in which there has been discrimination in favour of Conservative figures. Despite the brevity of the list and the paucity of information on it, we were able to identify six Conservative councillors, or former Conservative councillors, among the 28 new appointments. There we have it: three Labour figures go and six Conservative councillors come in, including Conservative councillors appointed to such obvious Conservative strongholds as North Tyneside and Bloomsbury—places where the local Conservative party might be well advised to put in a bid for proportional representation.
I hope that the Secretary of State will agree that this is an issue on which we undoubtedly have fresh information which was not available to us in Committee. That is the Secretary of State's own definition of what would make a valuable debate on Report. Therefore, surely that is the sort of issue which we should aim to reach and have a full debate in the House so that we can press the Secretary of State to tell us a little more about his list and justify the fact that, having applied his mind to the qualifications, experience and fitness for office of those people, he came to the remarkable conclusion that those who were fit for the posts were overwhelmingly Conservative and those who were unfit were, almost without exception, Labour.

Mr. Kenneth Clarke: That is not true.

Mr. Cook: The Secretary of State says that it is not true. That is precisely the point on which we wish to have a debate.

Mr. Clarke: We last made these appointments when the hon. Member for Oldham, West (Mr. Meacher) filled the position that the hon. Gentleman now occupies. The hon. Member for Oldham, West tried to mount a great political campaign, again trying to prove that the appointment of chairmanships to district health authorities were all party-politically motivated. He sent out a highly contentious letter quizzing people about their political allegiance. The only thing that the hon. Member for Oldham, West succeeded in doing was not improving the case, but provoking the chairman of a district health authority who had previously been a Labour party member into resigning from the Labour party because he was so shocked by the way in which the hon. Member was handling the matter.

Mr. Cook: The Secretary of State is perfectly correct: the one good thing to come out of that circular letter was the resignation of Eric Moonman from the Labour party.
In his intervention, the Secretary of State has made the case for the debate. I concede with enthusiasm and anticipation that he wants to get in there and mix it with me. He wants to defend his position and attack not me, but my predecessor. I am happy to accommodate him. I am here; he is here. We are both in the prime flush of youth, and plainly on form. We are both at a time when it is convenient to press ahead with the debate.

Mrs. Mahon: Does my hon. Friend agree that the one thing that sticks in everybody's throat about such antics—it is nepotism—is that the Conservative party criticises those in states in eastern Europe who have put their friends and political allies into positions, but the Tories do exactly the same? There is no difference between them. They


sacked a member of the Labour party in Calderdale three or four years ago simply on the say-so of the very Tory chairman.

Mr. Cook: I suspect that the spirit of Erich Honecker is alive and well and lurking in the Department of Health. It is precisely the centralised appointment of safe people within the party machine that is now discredited throughout eastern Europe.

Mr. Flannery: My hon. Friend the Member for Halifax (Mrs. Mahon) rightly said that that occurred a long time ago in many cases. The Secretary of State knows, from long before he held his exalted position, that there was a Labour chair of the Trent regional health authority. In Sheffield, there was a Tory chair. That created a balance. As soon as the Tories took over, they sacked the Trent chairman, promoted the Tory chair of Sheffield to Trent and put in another Tory at Sheffield. The same is happening now. The guillotine will come with its resident Madame Defarge.

Mr. Cook: I am grateful to my hon. Friend for his intervention.

Mr. Bermingham: The Secretary of State is aware that my old adversary, who happened to be a party member and chairman of my district health authority, was also disposed of. We do not have anyone who reflects the thinking of the Merseyside area. It would be helpful if the Secretary of State did not simply issue names, but told us a little about the appointees so that we would know how to judge them when we have to deal with them. That is especially important at a time when the Government are trying to privatise our hospitals and dispose of the care services. We should have the right to know about those with whom we will be dealing. Of course, the Secretary of State does not believe in glasnost or perestroika; he believes only in the jazz clubs.

Mr. Cook: Had the Secretary of State been inclined to appoint to the chairs of district health authorities a few more of those whom he meets at the jazz clubs, I might have been happier with the list last Friday.

Mr. Kenneth Clarke: The hon. Gentleman is serving a public function. My recollection of the chairman of Trent, who retired early in this Government's period of office, is that he was a former Liberal parish councillor who was in his 70s when he was replaced by a younger man. I pay tribute to the former chairman of St. Helens for his time in office. He was a Labour party member, but as the hon. Member for St. Helens, South (Mr. Bermingham) knows, I appointed him to the chair of that health authority. It is ridiculous to attempt to put together a conspiracy theory from a list of names that is not motivated by party politics.

Mr. Deputy Speaker (Sir Paul Dean): Order. It has been difficult to relate the past 10 minutes directly to the motion before the House.

Mr. Cook: I take your comment to heart, Mr. Deputy Speaker. I shall respond briefly to the Secretary of State's remarks and then move on to another subject.
It is true that the right hon. and learned Gentleman appointed Mr. McNamara—and he also sacked him. The question that arose sharply from that list on Friday was not so much the departure of Dr. Dunwoody—he is a former Labour Member of Parliament—as the fact that,

when the right hon. and learned Gentleman came to replace him, he did not appoint the obvious and logical person—Helene Hayman, who had served on the authority for more than a year as vice-chairman, and is another former Labour Member of Parliament—but instead appointed Sir Alan Greengross, who is a leader of Conservative councillors in London and who had been serving on that health authority only since January. It is patent that he was appointed in January so that he could take over as chair in March.
Leaving aside the departure of Dr. Dunwoody, it is impossible not to view the choice of an outside Conservative councillor, in preference to the inside former Labour Member, as anything other than clear political bias.

Mr. Bradley: I have noticed the enthusiasm of the Secretary of State for joining in the debate. Accepting that Mr. Gordan Legat of South Manchester health authority asked not to be reappointed, will the right hon. and learned Gentleman explain to the people of South Manchester exactly what connection Mr. Peter Hadfield has with the local communities of Withington and Wythenshawe? What is that gentleman's experience of health care mattes s?

Mr. Cook: I shall give way to the Secretary of State so that he can answer my hon. Friend.

Mr. Kenneth Clarke: It is true that Mr. Legat asked not to be reappointed, so I hope that he is not being added to the list of political purges that I am supposed to have carried out. I do not think that he is a member of the Labour party, although I am not aware of his politics. I am sure that his successor will be found to be extremely good.
In case people think that we are making light of the name of Dr. John Dunwoody, who was an excellent chairman of Bloomsbury district health authority, I must point out that I reappointed him. When I was last involved in these matters, I extended his period of chairmanship—despite the fact that he is an ex-Labour Minister, let alone a Labour Member of Parliament. He would have preferred to have another year in place before handing over his responsibilities, but we decided that it was the right time to change. It was a question of when to replace him.
It is not right to canvass in the Chamber, in our admittedly light-hearted debate, the name of such a distinguished chairman, leaving the impression that he was sacked on party-political grounds. He was not. He had a good innings as chairman. As far as I am aware, throughout his time in that post we always got on extremely well together and I admired his work. However, I thought that this year was the time to change, not next year.

Mr. Deputy Speaker: Order. I remind both Front-Bench spokesmen that they are moving a long way away from the motion.

Mr. Cook: I shall content myself with saying that the right hon. and learned Gentleman's intervention makes the case for a debate on this issue and that is why we are resisting the motion to report progress.
Looking back over the past 20 hours—and I say this in a spirit of comradeliness——

Mr. Renton: rose in his place and claimed to move, That the Question be now put.

Question put, That the Question be now put:—

The House proceeded to a Division—

Mr. Kirkwood: (seated and covered): On a point of order, Mr. Deputy Speaker.

Mr. Deputy Speaker: I will take it after the Division.

Mr. Kirkwood: (seated and covered): On a point of order on the Division, Mr. Deputy Speaker. I would value your advice on the reason for calling the Division. It was, as you know, a closure motion, and it was a closure motion on a procedural motion——

Mr. Deputy Speaker: Order. The hon. Gentleman is getting close to questioning the judgment of the Chair. The closure was moved. I accepted it. We are now proceeding to a Division on it. There can be no further argument about that.

Mr. Kirkwood: (seated and covered): On a point of order, Mr. Deputy Speaker. I am in no way seeking to confront your judgment. It is noticeable that there was only one speech in the debate——

Mr. Deputy Speaker: Order. The hon. Gentleman is now proceeding to do what he said he would not do, which is to question the judgment of the Chair.

Mr. Kirkwood: Simply——

Mr. Deputy Speaker: Order.

The House having divided: Ayes 244, Noes 166.

Division No. 120]
[11 47 am


AYES


Alexander, Richard
Carlisle, John, (Luton N)


Alison, Rt Hon Michael
Carlisle, Kenneth (Lincoln)


Amery, Rt Hon Julian
Carrington, Matthew


Amos, Alan
Cash, William


Arbuthnot, James
Chalker, Rt Hon Mrs Lynda


Arnold, Jacques (Gravesham)
Channon, Rt Hon Paul


Arnold, Tom (Hazel Grove)
Chapman, Sydney


Atkins, Robert
Churchill, Mr


Baker, Rt Hon K. (Mole Valley)
Clark, Sir W. (Croydon S)


Baker, Nicholas (Dorset N)
Clarke, Rt Hon K. (Rushcliffe)


Baldry, Tony
Colvin, Michael


Banks, Robert (Harrogate)
Conway, Derek


Beaumont-Dark, Anthony
Coombs, Anthony (Wyre F'rest)


Bellingham, Henry
Coombs, Simon (Swindon)


Bendall, Vivian
Cope, Rt Hon John


Bennett, Nicholas (Pembroke)
Cormack, Patrick


Benyon, W.
Cran, James


Bitten, Rt Hon John
Critchley, Julian


Blaker, Rt Hon Sir Peter
Currie, Mrs Edwina


Body, Sir Richard
Curry, David


Bonsor, Sir Nicholas
Davies, Q. (Stamf'd &amp; Spald'g)


Boscawen, Hon Robert
Day, Stephen


Boswell, Tim
Devlin, Tim


Bottomley, Mrs Virginia
Dickens, Geoffrey


Bowden, A (Brighton K'pto'n)
Dorrell, Stephen


Bowden, Gerald (Dulwich)
Douglas-Hamilton, Lord James


Bowis, John
Durant, Tony


Brandon-Bravo, Martin
Fallon, Michael


Brazier, Julian
Favell, Tony


Bright, Graham
Field, Barry (Isle of Wight)


Brooke, Rt Hon Peter
Fishburn, John Dudley


Brown, Michael (Brigg &amp; Cl't's)
Forman, Nigel


Bruce, Ian (Dorset South)
Forsyth, Michael (Stirling)


Buck, Sir Antony
Forth, Eric


Burns, Simon
Fowler, Rt Hon Sir Norman


Butcher, John
Fox, Sir Marcus


Butler, Chris
Franks, Cecil


Butterfill, John
Freeman, Roger





French, Douglas
Maude, Hon Francis


Gale, Roger
Maxwell-Hyslop, Robin


Gardiner, George
Mayhew, Rt Hon Sir Patrick


Garel-Jones, Tristan
Mellor, David


Gill, Christopher
Meyer, Sir Anthony


Gilmour, Rt Hon Sir Ian
Mills, Iain


Glyn, Dr Sir Alan
Mitchell, Andrew (Gedling)


Gorman, Mrs Teresa
Mitchell, Sir David


Gow, Ian
Monro, Sir Hector


Grant, Sir Anthony (CambsSW)
Moore, Rt Hon John


Greenway, Harry (Ealing N)
Neale, Gerrard


Greenway, John (Ryedale)
Nelson, Anthony


Gregory, Conal
Neubert, Michael


Griffiths, Peter (Portsmouth N)
Nicholls, Patrick


Grist, Ian
Nicholson, Emma (Devon West)


Hague, William
Onslow, Rt Hon Cranley


Hamilton, Neil (Tatton)
Paice, James


Hampson, Dr Keith
Parkinson, Rt Hon Cecil


Hanley, Jeremy
Patnick, Irvine


Hannam, John
Patten, Rt Hon Chris (Bath)


Harris, David
Patten, Rt Hon John


Haselhurst, Alan
Peacock, Mrs Elizabeth


Hawkins, Christopher
Porter, Barry (Wirral S)


Hayes, Jerry
Price, Sir David


Hayhoe, Rt Hon Sir Barney
Raffan, Keith


Hayward, Robert
Raison, Rt Hon Timothy


Heathcoat-Amory, David
Rathbone, Tim


Hicks, Mrs Maureen (Wolv' NE)
Redwood, John


Hicks, Robert (Cornwall SE)
Renton, Rt Hon Tim


Hind, Kenneth
Rhodes James, Robert


Hogg, Hon Douglas (Gr'th'm)
Ridsdale, Sir Julian


Holt, Richard
Rifkind, Rt Hon Malcolm


Hordern, Sir Peter
Roberts, Wyn (Conwy)


Howarth, Alan (Strat'd-on-A)
Rossi, Sir Hugh


Howell, Rt Hon David (G'dford)
Rowe, Andrew


Howell, Ralph (North Norfolk)
Rumbold, Mrs Angela


Hughes, Robert G. (Harrow W)
Ryder, Richard


Hurd, Rt Hon Douglas
Sayeed, Jonathan


Irvine, Michael
Scott, Rt Hon Nicholas


Irving, Sir Charles
Shaw, Sir Michael (Scarb')


Jack, Michael
Shelton, Sir William


Jackson, Robert
Shephard, Mrs G. (Norfolk SW)


Janman, Tim
Shepherd, Colin (Hereford)


Jessel, Toby
Sims, Roger


Johnson Smith, Sir Geoffrey
Skeet, Sir Trevor


Jones, Gwilym (Cardiff N)
Smith, Sir Dudley (Warwick)


Jones, Robert B (Herts W)
Smith, Tim (Beaconsfield)


Jopling, Rt Hon Michael
Speller, Tony


Kellett-Bowman, Dame Elaine
Spicer, Sir Jim (Dorset W)


King, Roger (B'ham N'thfield)
Spicer, Michael (S Worcs)


Kirkhope, Timothy
Squire, Robin


Knapman, Roger
Stanbrook, Ivor


Knight, Greg (Derby North)
Stevens, Lewis


Knight, Dame Jill (Edgbaston)
Stewart, Allan (Eastwood)


Knox, David
Stewart, Andy (Sherwood)


Lang, Ian
Stewart, Rt Hon Ian (Herts N)


Latham, Michael
Stradling Thomas, Sir John


Lawson, Rt Hon Nigel
Summerson, Hugo


Lee, John (Pendle)
Taylor, John M (Solihull)


Leigh, Edward (Gainsbor'gh)
Temple-Morris, Peter


Lester, Jim (Broxtowe)
Thompson, D. (Calder Valley)


Lightbown, David
Thompson, Patrick (Norwich N)


Lilley, Peter
Thorne, Neil


Lloyd, Sir Ian (Havant)
Thornton, Malcolm


Lloyd, Peter (Fareham)
Thurnham, Peter


Lord, Michael
Townsend, Cyril D. (B'heath)


Luce, Rt Hon Richard
Tracey, Richard


McCrindle, Robert
Tredinnick, David


MacGregor, Rt Hon John
Trippier, David


MacKay, Andrew (E Berkshire)
Trotter, Neville


Maclean, David
Twinn, Dr Ian


McLoughlin, Patrick
Waldegrave, Rt Hon William


Madel, David
Walker, Rt Hon P. (W'cester)


Malins, Humfrey
Waller, Gary


Mans, Keith
Ward, John


Maples, John
Wardle, Charles (Bexhill)


Marland, Paul
Watts, John


Marshall, John (Hendon S)
Wells, Bowen


Marshall, Michael (Arundel)
Wheeler, Sir John


Martin, David (Portsmouth S)
Widdecombe, Ann






Wiggin, Jerry
Yeo, Tim


Wilkinson, John
Young, Sir George (Acton)


Wilshire, David



Wolfson, Mark
Tellers for the Ayes:


Wood, Timothy
Mr. Alistair Goodlad and Mr. Tom Sackville.


Woodcock, Dr. Mike



NOES


Abbott, Ms Diane
Heffer, Eric S.


Adams, Allen (Paisley N)
Henderson, Doug


Alton, David
Hinchliffe, David


Anderson, Donald
Home Robertson, John


Armstrong, Hilary
Hood, Jimmy


Ashton, Joe
Howells, Geraint


Barnes, Harry (Derbyshire NE)
Howells, Dr. Kim (Pontypridd)


Battle, John
Hoyle, Doug


Beggs, Roy
Hughes, John (Coventry NE)


Beith, A. J.
Hughes, Robert (Aberdeen N)


Benn, Rt Hon Tony
Hughes, Roy (Newport E)


Bennett, A. F. (D'nt'n &amp; R'dish)
Hughes, Sean (Knowsley S)


Blair, Tony
Hughes, Simon (Southwark)


Blunkett. David
Ingram, Adam


Boateng, Paul
Jones, Barry (Alyn &amp; Deeside)


Bradley, Keith
Jones, leuan (Ynys Môn)


Brown, Gordon (D'mline E)
Jones, Martyn (Clwyd S W)


Brown, Nicholas (Newcastle E)
Kilfedder, James


Bruce, Malcolm (Gordon)
Kirkwood, Archy


Buckley, George J.
Lamond, James


Caborn, Richard
Lewis, Terry


Campbell, Ron (Blyth Valley)
Livingstone, Ken


Campbell-Savours, D. N.
Livsey, Richard


Clark, Dr David (S Shields)
Lloyd, Tony (Stretford)


Clarke, Tom (Monklands W)
Loyden, Eddie


Clay, Bob
McCartney, Ian


Clwyd, Mrs Ann
Macdonald, Calum A.


Cohen, Harry
McFall, John


Coleman, Donald
McKay, Allen (Barnsley West)


Cook, Frank (Stockton N)
McKelvey, William


Cook, Robin (Livingston)
McLeish, Henry


Corbett, Robin
McNamara, Kevin


Cousins, Jim
Madden, Max


Cox, Tom
Mahon, Mrs Alice


Crowther, Stan
Marek, Dr John


Cryer, Bob
Marshall, Jim (Leicester S)


Cummings, John
Martlew, Eric


Dalyell, Tarn
Maxton, John


Davies, Rt Hon Denzil (Llanelli)
Meacher, Michael


Davis, Terry (B'ham Hodge H'l)
Meale, Alan


Dewar, Donald
Michael, Alun


Dixon, Don
Michie, Bill (Sheffield Heeley)


Douglas, Dick
Molyneaux, Rt Hon James


Duffy, A. E. P.
Morgan, Rhodri


Dunnachie, Jimmy
Morley, Elliot


Eadie, Alexander
Morris, Rt Hon A. (W'shawe)


Eastham, Ken
Mowlam, Marjorie


Ewing, Harry (Falkirk E)
Mullin, Chris


Faulds, Andrew
Murphy, Paul


Field, Frank (Birkenhead)
Nellist, Dave


Fields, Terry (L'pool B G'n)
O'Brien, William


Fisher, Mark
Orme, Rt Hon Stanley


Flannery, Martin
Patchett, Terry


Flynn, Paul
Pike, Peter L.


Foot, Rt Hon Michael
Powell, Ray (Ogmore)


Forsythe, Clifford (Antrim S)
Prescott, John


Foster, Derek
Primarolo, Dawn


Foulkes, George
Radice, Giles


Galloway, George
Redmond, Martin


Garrett, John (Norwich South)
Rees, Rt Hon Merlyn


Garrett, Ted (Wallsend)
Richardson, Jo


George, Bruce
Robertson, George


Gilbert, Rt Hon Dr John
Rooker, Jeff


Golding, Mrs Llin
Ross, Ernie (Dundee W)


Gould, Bryan
Ross, William (Londonderry E)


Graham, Thomas
Rowlands, Ted


Griffiths, Nigel (Edinburgh S)
Ruddock, Joan


Griffiths, Win (Bridgend)
Salmond, Alex


Hardy, Peter
Sheerman, Barry


Harman, Ms Harriet
Sheldon, Rt Hon Robert


Hattersley, Rt Hon Roy
Shore, Rt Hon Peter


Haynes, Frank
Sillars, Jim





Smith, C. (Isl'ton &amp; F'bury)
Wallace, James


Smith, Rt Hon J. (Monk'ds E)
Wardell, Gareth (Gower)


Smith, J. P. (Vale of Glam)
Welsh, Michael (Doncaster N)


Smyth, Rev Martin (Belfast S)
Wigley, Dafydd


Soley, Clive
Williams, Alan W. (Carm'then)


Spearing, Nigel
Wise, Mrs Audrey


Steel, Rt Hon Sir David
Worthington, Tony


Steinberg, Gerry
Wray, Jimmy


Straw, Jack
Young, David (Bolton SE)


Taylor, Rt Hon J. D. (S'ford)



Taylor, Matthew (Truro)
Tellers for the Noes:


Thomas, Dr Dafydd Elis
Mr. Dennis Skinner and Mr. Gerald Bermingham.


Thompson, Jack (Wansbeck)

Question accordingly agreed to.

Question put accordingly, That further consideration of the Bill be now adjourned:—

The House divided: Ayes 254, Noes 169.

Division No. 121]
M[11.59 pm


AYES


Alexander, Richard
Critchley, Julian


Alison, Rt Hon Michael
Currie, Mrs Edwina


Allason, Rupert
Curry, David


Amery, Rt Hon Julian
Davies, Q. (Stamf'd &amp; Spald'g)


Amos, Alan
Day, Stephen


Arbuthnot, James
Devlin, Tim


Arnold, Jacques (Gravesham)
Dickens, Geoffrey


Arnold, Tom (Hazel Grove)
Dorrell, Stephen


Atkins, Robert
Douglas-Hamilton, Lord James


Baker, Rt Hon K. (Mole Valley)
Dover, Den


Baker, Nicholas (Dorset N)
Durant, Tony


Baldry, Tony
Fallon, Michael


Banks, Robert (Harrogate)
Favell, Tony


Beaumont-Dark, Anthony
Field, Barry (Isle of Wight)


Bellingham, Henry
Fishburn, John Dudley


Bendall, Vivian
Forman, Nigel


Bennett, Nicholas (Pembroke)
Forsyth, Michael (Stirling)


Benyon, W.
Forth, Eric


Biffen, Rt Hon John
Fowler, Rt Hon Sir Norman


Blaker, Rt Hon Sir Peter
Fox, Sir Marcus


Body, Sir Richard
Franks, Cecil


Bonsor, Sir Nicholas
Freeman, Roger


Boscawen, Hon Robert
French, Douglas


Boswell, Tim
Gale, Roger


Bottomley, Mrs Virginia
Gardiner, George


Bowden, A (Brighton K'pto'n)
Garel-Jones, Tristan


Bowden, Gerald (Dulwich)
Gill, Christopher


Bowis, John
Gilmour, Rt Hon Sir Ian


Brandon-Bravo, Martin
Glyn, Dr Sir Alan


Brazier, Julian
Gorman, Mrs Teresa


Bright, Graham
Gow, Ian


Brooke, Rt Hon Peter
Grant, Sir Anthony (CambsSW)


Brown, Michael (Brigg &amp; CI't's)
Greenway, Harry (Ealing N)


Bruce, Ian (Dorset South)
Greenway, John (Ryedale)


Buck, Sir Antony
Gregory, Conal


Burns, Simon
Griffiths, Peter (Portsmouth N)


Butcher, John
Grist, Ian


Butler, Chris
Grylls, Michael


Butterfill, John
Hague, William


Carlisle, John, (Luton N)
Hamilton, Hon Archie (Epsom)


Carlisle, Kenneth (Lincoln)
Hamilton, Neil (Tatton)


Carrington, Matthew
Hampson, Dr Keith


Carttiss, Michael
Hanley, Jeremy


Cash, William
Hannam, John


Chalker, Rt Hon Mrs Lynda
Harris, David


Channon, Rt Hon Paul
Haselhurst, Alan


Chapman, Sydney
Hawkins, Christopher


Churchill, Mr
Hayhoe, Rt Hon Sir Barney


Clark, Sir W. (Croydon S)
Hayward, Robert


Clarke, Rt Hon K. (Rushcliffe)
Heathcoat-Amory, David


Colvin, Michael
Hicks, Mrs Maureen (Wolv' NE)


Conway, Derek
Hicks, Robert (Cornwall SE)


Coombs, Anthony (Wyre F'rest)
Hind, Kenneth


Coombs, Simon (Swindon)
Hogg, Hon Douglas (Gr'th'm)


Cope, Rt Hon John
Holt, Richard


Cormack, Patrick
Hordern, Sir Peter


Couchman, James
Howarth, Alan (Strat'd-on-A)


Cran, James
Howell, Rt Hon David (G'dford)






Howell, Ralph (North Norfolk)
Price, Sir David


Hughes, Robert G. (Harrow W)
Raffan, Keith


Hurd, Rt Hon Douglas
Raison, Rt Hon Timothy


Irvine, Michael
Rathbone, Tim


Irving, Sir Charles
Redwood, John


Jack, Michael
Renton, Rt Hon Tim


Jackson, Robert
Rhodes James, Robert


Janman, Tim
Ridsdale, Sir Julian


Jessel, Toby
Rifkind, Rt Hon Malcolm


Johnson Smith, Sir Geoffrey
Roberts, Wyn (Conwy)


Jones, Gwilym (Cardiff N)
Rossi, Sir Hugh


Jones, Robert B (Herts W)
Rowe, Andrew


Jopling, Rt Hon Michael
Rumbold, Mrs Angela


Kellett-Bowman, Dame Elaine
Ryder, Richard


King, Roger (B'ham N'thfield)
Sayeed, Jonathan


Kirkhope, Timothy
Scott, Rt Hon Nicholas


Knapman, Roger
Shaw, Sir Michael (Scarb')


Knight, Greg (Derby North)
Shelton, Sir William


Knight, Dame Jill (Edgbaston)
Shephard, Mrs G. (Norfolk SW)


Knox, David
Shepherd, Colin (Hereford)


Lang, Ian
Sims, Roger


Latham, Michael
Skeet, Sir Trevor


Lawson, Rt Hon Nigel
Smith, Sir Dudley (Warwick)


Lee, John (Pendle)
Smith, Tim (Beaconsfield)


Leigh, Edward (Gainsbor'gh)
Speller, Tony


Lester, Jim (Broxtowe)
Spicer, Sir Jim (Dorset W)


Lightbown, David
Spicer, Michael (S Worcs)


Lilley, Peter
Squire, Robin


Lloyd, Sir Ian (Havant)
Stanbrook, Ivor


Lloyd, Peter (Fareham)
Stevens, Lewis


Lord, Michael
Stewart, Allan (Eastwood)


Luce, Rt Hon Richard
Stewart, Andy (Sherwood)


McCrindle, Robert
Stewart, Rt Hon Ian (Herts N)


MacGregor, Rt Hon John
Stradling Thomas, Sir John


MacKay, Andrew (E Berkshire)
Summerson, Hugo


Maclean, David
Taylor, John M (Solihull)


McLoughlin, Patrick
Taylor, Teddy (S'end E)


Madel, David
Temple-Morris, Peter


Malins, Humfrey
Thompson, D. (Calder Valley)


Mans, Keith
Thompson, Patrick (Norwich N)


Maples, John
Thorne, Neil


Marland, Paul
Thornton, Malcolm


Marshall, John (Hendon S)
Thurnham, Peter


Marshall, Michael (Arundel)
Townsend, Cyril D. (B'heath)


Martin, David (Portsmouth S)
Tracey, Richard


Maude, Hon Francis
Tredinnick, David


Maxwell-Hyslop, Robin
Trippier, David


Mayhew, Rt Hon Sir Patrick
Trotter, Neville


Mellor, David
Twinn, Dr Ian


Meyer, Sir Anthony
Waldegrave, Rt Hon William


Mills, Iain
Walker, Bill (T'side North)


Mitchell, Andrew (Gedling)
Walker, Rt Hon P. (W'cester)


Mitchell, Sir David
Waller, Gary


Moate, Roger
Ward, John


Monro, Sir Hector
Wardle, Charles (Bexhill)


Montgomery, Sir Fergus
Watts, John


Moore, Rt Hon John
Wells, Bowen


Moynihan, Hon Colin
Wheeler, Sir John


Neale, Gerrard
Widdecombe, Ann


Nelson, Anthony
Wiggin, Jerry


Neubert, Michael
Wilkinson, John


Nicholls, Patrick
Wilshire, David


Nicholson, Emma (Devon West)
Wolfson, Mark


Onslow, Rt Hon Cranley
Wood, Timothy


Paice, James
Woodcock, Dr. Mike


Parkinson, Rt Hon Cecil
Yeo, Tim


Patnick, Irvine
Young, Sir George (Acton)


Patten, Rt Hon Chris (Bath)



Patten, Rt Hon John
Tellers for the Ayes:


Peacock, Mrs Elizabeth
Mr. Alastair Goodlad and Mr. Tom Sackville.


Porter, David (Waveney)



NOES


Abbott, Ms Diane
Ashton, Joe


Adams, Allen (Paisley N)
Barnes, Harry (Derbyshire NE)


Allen, Graham
Barron, Kevin


Alton, David
Battle, John


Anderson, Donald
Beggs, Roy


Armstrong, Hilary
Beith, A. J.


Ashdown, Rt Hon Paddy
Benn, Rt Hon Tony





Bennett, A. F. (D'nt'n &amp; R'dish)
Kilfedder, James


Bermingham, Gerald
Kirkwood, Archy


Blair, Tony
Lamond, James


Blunkett, David
Lewis, Terry


Boateng, Paul
Livingstone, Ken


Bradley, Keith
Livsey, Richard


Brown, Gordon (D'mline E)
Lloyd, Tony (Stretford)


Brown, Nicholas (Newcastle E)
Loyden, Eddie


Bruce, Malcolm (Gordon)
McCartney, Ian


Buchan, Norman
Macdonald, Calum A.


Buckley, George J.
McFall, John


Caborn, Richard
McKay, Allen (Barnsley West)


Campbell, Ron (Blyth Valley)
McKelvey, William


Campbell-Savours, D. N.
McLeish, Henry


Clark, Dr David (S Shields)
McNamara, Kevin


Clarke, Tom (Monklands W)
Madden, Max


Clay, Bob
Mahon, Mrs Alice


Clwyd, Mrs Ann
Marek, Dr John


Cohen, Harry
Marshall, Jim (Leicester S)


Coleman, Donald
Martlew, Eric


Cook, Frank (Stockton N)
Maxton, John


Cook, Robin (Livingston)
Meacher, Michael


Corbett, Robin
Meale, Alan


Cousins, Jim
Michael, Alun


Cox, Tom
Michie, Bill (Sheffield Heeley)


Crowther, Stan
Molyneaux, Rt Hon James


Cryer, Bob
Morgan, Rhodri


Cummings, John
Morley, Elliot


Dalyell, Tarn
Mowlam, Marjorie


Davies, Rt Hon Denzil (Llanelli)
Mullin, Chris


Davis, Terry (B'ham Hodge H'I)
Murphy, Paul


Dewar, Donald
Nellist, Dave


Dixon, Don
O'Brien, William


Douglas, Dick
Orme, Rt Hon Stanley


Duffy, A. E. P.
Patchett, Terry


Dunnachie, Jimmy
Pike, Peter L.


Eadie, Alexander
Powell, Ray (Ogmore)


Eastham, Ken
Prescott, John


Evans, John (St Helens N)
Primarolo, Dawn


Ewing, Harry (Falkirk E)
Radice, Giles


Faulds, Andrew
Redmond, Martin


Fearn, Ronald
Rees, Rt Hon Merlyn


Field, Frank (Birkenhead)
Richardson, Jo


Fields, Terry (L'pool B G'n)
Robertson, George


Fisher, Mark
Ross, Ernie (Dundee W)


Flannery, Martin
Ross, William (Londonderry E)


Flynn, Paul
Rowlands, Ted


Foot, Rt Hon Michael
Ruddock, Joan


Forsythe, Clifford (Antrim S)
Salmond, Alex


Foster, Derek
Sheerman, Barry


Foulkes, George
Sheldon, Rt Hon Robert


Galloway, George
Shore, Rt Hon Peter


Garrett, John (Norwich South)
Sillars, Jim


Garrett, Ted (Wallsend)
Skinner, Dennis


George, Bruce
Smith, C. (Isl'ton &amp; F'bury)


Gilbert, Rt Hon Dr John
Smith, Rt Hon J. (Monk'ds E)


Graham, Thomas
Smith, J. P. (Vale of Glam)


Griffiths, Nigel (Edinburgh S)
Smyth, Rev Martin (Belfast S)


Griffiths, Win (Bridgend)
Soley, Clive


Hardy, Peter
Spearing, Nigel


Harman, Ms Harriet
Steel, Rt Hon Sir David


Hattersley, Rt Hon Roy
Steinberg, Gerry


Heffer, Eric S.
Straw, Jack


Henderson, Doug
Taylor, Rt Hon J. D. (S'ford)


Hinchliffe, David
Taylor, Matthew (Truro)


Hoey, Ms Kate (Vauxhall)
Thompson, Jack (Wansbeck)


Home Robertson, John
Wallace, James


Hood, Jimmy
Warded, Gareth (Gower)


Howells, Geraint
Wareing, Robert N.


Howells, Dr. Kim (Pontypridd)
Welsh, Michael (Doncaster N)


Hoyle, Doug
Wigley, Dafydd


Hughes, John (Coventry NE)
Williams, Rt Hon Alan


Hughes, Robert (Aberdeen N)
Wilson, Brian


Hughes, Roy (Newport E)
Wise, Mrs Audrey


Hughes, Sean (Knowsley S)
Worthington, Tony


Hughes, Simon (Southwark)
Young, David (Bolton SE)


Ingram, Adam



Jones, Barry (Alyn &amp; Deeside)
Tellers for the Noes:


Jones, Ieuan (Ynys Môn)
Mr. Frank Haynes and Mrs. Llin Golding.


Jones, Martyn (Clwyd S W)

Question accordingly agreed to.

Bill to be further considered this day.

Orders of the Day — Business of the House

The Parliamentary Secretary to the Treasury (Mr. Tim Renton): With permission, Mr. Speaker, I should like to make a statement about the re-arranged business for this week:

WEDNESDAY 14 MARCH—Timetable motion on the National Health Service and Community Care Bill.
Completion of Report stage of the National Health Service and Community Care Bill.
THURSDAY 15 MARCH—Until about seven o'clock, Third Reading of the National Health Service and Community Care Bill.
Consideration of Lords amendments to the Coal Industry Bill.
Motion to amend schedule Ito the House of Commons Disqualification Act 1975.
The Chairman of Ways and Means has named opposed private business for consideration at seven o'clock.
At ten o'clock, the Question will be put on all outstanding supplementary estimates and votes.

Mr. Robin Cook: As, on this occasion, the business statement was made, unusually, by the Patronage Secretary, may I begin by asking the right hon. Gentleman whether he is confident that his Whips Office will deliver a majority for the guillotine motion this afternoon? Is he aware that the deeply unpopular National Health Service and Community Care Bill now threatens to damage democracy as much as it threatens to damage the Health Service?
Is the right hon. Gentleman aware that the Bill, which gives local people no say about whether their hospital opts out of the NHS, is now to be forced through Parliament at a pace that gives Parliament no opportunity for a proper debate? Has the right hon. Gentleman counted the selection that remains before the House? Is he aware that it includes 40 new clauses and 212 amendments, of which 100 are Government amendments? How does he propose that the House should give proper scrutiny to those outstanding 250 items for debate in the timetable that he has stated?
Is the real reason for the timetable motion to curtail the debate, not of the Opposition, but of Conservative Members? As he is Patronage Secretary, will the right hon.Gentleman explain to the country outside why a Government with a record majority require a record number of guillotines to get their business through the House?

Mr. Renton: If he remembers what it was, the answer to the hon. Gentleman's first question is, "Yes, Sir." In answer to his second point, there is no question of the timetable motion damaging democracy in this House. It is rather that the hon. Gentleman's speeches have damaged the procedures of the House.
The hon. Gentleman gave the game away earlier this morning when we were debating the motion to report progress. He said that he was getting into his stride, because we were in prime time. In the past five hours, the hon. Gentleman has made two speeches, one of one hour and 48 minutes and one of one hour and 11 minutes. He is suffering from what may indelicately be called "televised verbal diarrhoea". The sooner that the House can help the hon. Gentleman to find a cure, the better.

Mr. Archy Kirkwood: Does the right hon. Gentleman regard it as significant that, for the first time that I can recall, a major health Bill has been subject to a guillotine motion? Can the Patronage Secretary tell the House the last time that we had a guillotine on a major health Bill? The National Health Service Act 1946, which enjoyed a degree of consensus across the House, went through without a guillotine. I repeat: when was the last time that we had such a guillotine?
Will the right hon. Gentleman confirm that each of the 100 Government amendments will potentially have to be put to a vote under the timetable motion? In what way will the timetable motion take account of the amount of time that will be necessary for those Divisions?
Finally, does the right hon. Gentleman accept that the people of Scotland, who will be deprived of a huge chunk of Scottish legislation, will wonder why we burden the House with such an amount of business that we cannot discuss it properly, when we could have the viable alternative of a Scottish Parliament that could give proper debate to important matters of Scottish business?

Mr. Renton: I am pleased that the hon. Gentleman asked me his first question. The last time that a health Bill was guillotined was in 1976, when the Labour Government guillotined the Health Services Act 1976 after just 80 hours in Committee. Hon. Members who served on Standing Committee E will know that we have already spent 109 hours in Committee. This Committee stage was not guillotined by the Government, whereas the 1976 Act was guillotined in Committee, and on Report, and on Third Reading, and the timetable motion was introduced by the Labour Government after only 42 hours in Committee. That gives the hon. Gentleman his answer.
On the Scottish dimension to which the hon. Gentleman referred, he knows that Scottish Office and Welsh Office Ministers have been represented during our debates and there has been an ample separate Scottish debate for the many areas in which the legislation is separate. The hon. Gentleman will be able to raise points about the details of the timetable motion later this afternoon, when the timetable motion is debated.

Mr. Nigel Spearing: The Patronage Secretary has claimed that his proposals do not represent an intrinsic affront to democracy. Will he now tell the House the period in which he expects to be able to settle the timetable motion tomorrow? Will it run over the possible 18 hours that we could have, from about 6 pm this evening until midday tomorrow—through the night?
Is the right hon. Gentleman aware that the remaining new clauses and amendments relate to many important things that affect every citizen of this land, including dispensing from doctors, appointments to health authorities, carers, disabled people and every aspect of our National Health Service? Will he tell the House the timetable that he envisages?

Mr. Renton: The hon. Gentleman is a well-known expert on the procedures of the House and he knows as well as I do that the timetable motion will appear on Wednesday's Order Paper. The House is currently enjoying Tuesday; I am simply trying to give the House a Wednesday in which the timetable motion can be debated,

along with the Bill's remaining stages. The House will have an opportunity to debate the details of the timetable motion later.

Mr. Nicholas Bennett: Is my right hon. Friend aware that members of the public who are watching the proceedings of the Opposition will wonder what they have been up to? Those of us who served on the Standing Committee know that we had a sensible Committee stage in which the Opposition debated the clauses, new clauses and amendments at some length, but not at the length at which they debated the Report stage during the night. We have discussed only four clauses since yesterday afternoon. Is my right hon. Friend aware that, like his hon. Friend the Member for Livingston (Mr. Cook), the hon. Member for Cardiff, South and Penarth (Mr. Michael) spoke for half an hour in the middle of the night, moving a new clause which merely——

Mr. D. N. Campbell-Savours: On a point of order, Mr. Speaker.

Mr. Speaker: No. What the hon. Member for Pembroke (Mr. Bennett) has said has been perfectly in order.

Mr. Campbell-Savours: On a point of order, Mr. Speaker. May I ask you to intervene to protect Back-Bench rights? My hon. Friends have identified many new clauses and amendments that have to be spoken to——

Mr. Speaker: Order. If I call the hon. Gentleman to put a question to the Patronage Secretary, he can ask it. At the moment, I am hearing the hon. Member for Pembroke.

Mr. Campbell-Savours: The Patronage Secretary has not told the House the time that is to be available. I am asking you, Mr. Speaker——

Mr. Speaker: Order. That is not a point of order for me.

Mr. Bennett: Is my right hon. Friend aware that the hon. Member for Cardiff, South and Penarth (Mr. Michael) spoke for half an hour in the early hours of this morning? He moved a new clause, the only effect of which was to make the community health district council boundaries the same as the local authority boundaries. It took him half an hour to move the new clause and we had an hour's debate on it. Is it not time that the House got on with debating the Bill, which many of our constituents want to see on the statute book, so that we can bring in the reforms?

Mr. Joseph Ashton: On a point of order, Mr. Speaker.

Mr. Martin Flannery: On a point of order, Mr. Speaker. The hon. Member for Pembroke (Mr. Bennett) did not take account of the nature of the debate that takes place in the House after Committee stage. There is a wider grouping of people in the House on Report than in Committee. The hon. Gentleman seems to believe that that wider grouping should not discuss at any length the matters that have been discussed in Committee.

Mr. Speaker: I am not responsible for what the hon. Member for Pembroke (Mr. Bennett) seems to believe. Questions to the Patronage Secretary must be limited to


the business statement that he has just made. They must not raise arguments that should properly be raised when we come to discuss the guillotine motion.

Mr. Renton: I agree with my hon. Friend the Member for Pembroke (Mr. Bennett). The Committee stage was dominated by sensible and reasonably brief discussions. The Committee stage was completed in 109 hours. Up to the business motion, we spent 18 hours discussing a mere five new clauses.
There was clear agreement through the usual channels that two and a half days was sufficient for the whole debate. My right hon. and learned Friend the Leader of the House announced that in business questions last week. There was no comment on it from Opposition Members, except from the hon. Member for Belfast, South (Rev. Martin Smyth) who congratulated my right hon. and learned Friend on making as much as two and a half days available.
The Opposition have simply failed to deliver the agreement. We have discussed only five new clauses on the first day. If the business is to be concluded in two and a half days, there is a clear need to structure discussions more sensibly from now on.

Mr. Dafydd Wigley: Does the Patronage Secretary realise that, if the guillotine motion is passed, the important debate on disablement will almost certainly be lost? Is that not completely unacceptable? In view of the statement that he has just made on the general business, will he tell the House whether the Government will make a statement today or tomorrow on the appointment of a new Secretary of State for Wales? The appointment has been announced on the tapes but not to the House.
The present Secretary of State for Wales, the right hon. Member for Worcester (Mr. Walker) is carrying on as Secretary of State in Committee. His future position is uncertain. We do not know how long he will remain in office. In the meantime we have been landed with another governor-general, not elected by or answerable to the people of Wales, to do the Government's dirty work.

Mr. Speaker: Order. I am not certain that this has much relevance to the guillotine motion.

Mr. Renton: As the hon. Gentleman knows, Welsh Ministers have been represented on both Front Benches during the debate. There have been several separate debates on Wales, too.
On the appointment in due course of the new Secretary of State for Wales, I am sure that all my hon. Friends wish the new Secretary of State for Wales every success. [HON. MEMBERS: "Who is it?"] I am simply answering the hon. Gentleman's point. He can raise the other point of detail either on the timetable motion this afternoon or in business questions tomorrow.

Mr. Alun Michael: On a point of order, Mr. Speaker. The Patronage Secretary congratulated an individual on an appointment which has not been announced to the House. May I ask through you, Mr. Speaker, that the Patronage Secretary come to the Dispatch Box and tell the House the name or the constituency of the individual whom he has just congratulated?

Mr. Speaker: I am not aware that it has ever been the practice that ministerial changes are announced in the House. I call Mr. Bill Walker.

Mr. Ray Powell: On a point of order, Mr. Speaker.

Mr. Speaker: Is it to do with this statement?

Mr. Powell: My point of order is directed to you. I remind you of a point of order that I raised on a similar issue and the points of order that were raised on three occasions last week and in Business Questions on Thursday. It arises from whether we should have a statement about the successor to the right hon. Member for Worcester (Mr. Walker), who is now Secretary of State for Wales. We have had no statement from the Government. We ask the question yet again because the press and the media have been given the statement. It is an abuse for the Government to overlook the fact that hon. Members who represent Wales would like to be informed publicly and in the House who will be the successor to the person who has resigned.

Mr. Speaker: Order. Again, I cannot recollect that ministerial changes have to be announced in the House. That is a new doctrine altogether.

Mr. Campbell-Savours: On a point of order, Mr. Speaker.

Mr. Speaker: It is nothing to do with this statement.

Mr. Donald Anderson: On a point of order, Mr. Speaker. Of course it is not the practice that resignations are announced to the House. The point that my hon. Friend the Member for Ogmore (Mr. Powell) sought to make was that the Secretary of State for Wales is betwixt and between. He was in what must be a wholly impossible situation this morning. He appeared as the first Government speaker in the Welsh Grand Committee, after it had been announced on the tapes that he had been succeeded by his hon. Friend the Member for the poll tax, the Member for Wirral, West (Mr. Hunt). Clearly, the Secretary of State for Wales is in an impossible position. No one knew whether he was speaking with the authority of the Government or not.

Mr. Speaker: I understand that argument, but it has nothing to do with the statement or with me.

Mr. Campbell-Savours: On a point of order, Mr. Speaker.

Mr. Speaker: I shall take the hon. Member, as long as he is to the point.

Mr. Campbell-Savours: I raised an issue earlier. I put it to you that you are now—[Interruption.]

Mr. Speaker: Order. The hon. Gentleman does not need to be barracked from his own side.

Mr. Campbell-Savours: I do not need comments like that. You are now in conflict with Ministers. You have selected amendments and new clauses on the basis that sufficient time would be given for their debate. Ministers are curtailing the rights of hon. Members to debate these matters by introducing the guillotine motion. The conflict is not between us and Ministers; it is between you, as


selector of the amendments and the new clauses, and Ministers. You should advise Ministers what time should be given for further debate on the Bill. It is a serious—

Mr. Speaker: Order. That is another new doctrine. I have not heard it enunciated before. The Speaker's duty is to select the amendments.

Mr. Ray Powell: rose——

Mr. Speaker: Order. I am dealing with one question at a time. Of course I selected the amendments. I did so very generously. I do not bring in guillotine motions; that is a matter for the Government. That motion will be debated this afternoon.

Mr. Bill Walker: On a point of order, Mr. Speaker.

Mr. Speaker: Let us have the hon. Member's question. I called him to put his question to the Minister.

Mr. Walker: When I take the opportunity to put my question, may I draw it to your attention that I, too, represent a minority in Parliament? Minorities look to you in the Chair and whoever sits in the Chair in Committee to ensure that their rights are not abused. One of the reasons why the Order is important to us as minorities—my right hon. Friends on the Front Bench——

Mr. Speaker: Order. I certainly give the hon. Gentleman my protection but I would prefer that he put his question to the Patronage Secretary rather than to me. I cannot answer what he seeks to enunciate.

Mr. Walker: I understand that. I was on the point of addressing my question to my right hon. Friend. My point of order is important because of what I am about to say to him.
Does my right hon. Friend agree that a reason why the motion is so important to the interests of minorities is that, throughout the Committee stage, and, indeed, today, we have been exposed to bogus points of order, many of them from the hon. Member for Workington (Mr. Campbell-Savours)? He has taken up a great deal of time and the Chair has always replied "That is not a point of order for me." He has taken up more time than any contribution made by any Member on any specific narrow topic that we have debated.
That is why my right hon. Friend is right to introduce the motion. Those of us who have been present on Second Reading, throughout the Committee stage and through the night believe that minority interests, for which I speak in Scotland, must be heard in this Chamber. That is why we must deal with the offenders.

Mr. Renton: I thank my hon. Friend for his support. I agree with him that, over the past 18 hours, we have listened to the same speches as those made in Committee, but by and large in Committee they were made briefly, whereas over the past 18 hours they have been made at inordinate length.

Several Hon. Members: rose ——

Mr. Speaker: Order. I hope that I am not doing hon. Gentlemen a disservice, but if I may anticipate them, I am

not prepared to take any more points of order on the appointment of the Secretary of State for Wales of which I have no knowledge. I call Mr. Ashton.

Mr. Joseph Ashton: Is the Patronage Secretary aware that, when Bassetlaw health authority announced that it would opt out, it caused tremendous controversy and that the Secretary of State for Health had to smuggle himself past protest meetings into the local hospital in a small car? He gave an assurance that the matter would be debated in Parliament, there would be full consultation and nothing would pass without extensive consultations. Now we find that the Bill will go through on the nod this afternoon. How does he expect my constituents' protests to be made and democracy to work?

Mr. Renton: My right hon. and learned Friend the Secretary of State for Health is not normally considered capable of being smuggled quietly anywhere. That is not in his nature. The business motion deals only with the business before the House for the next two days. The hon. Gentleman will be able to ask the Secretary of State the point of substance and detail that he has made, during the debate on Wednesday or Thursday afternoon.

Mr. Roger Gale: As, last night, the Opposition lost every last vestige of credibility——

Several Hon. Members: On a point of order——

Mr. Speaker: Order. I called Mr. Gale.

Mr. Gale: As last night the Opposition lost every vestige of credibility that they might have had in the public eye by failing to be present in the Chamber to take part in a Division which they at least considered important, does my right hon. Friend think that on this occasion their anger might be just a little synthetic?

Mr. Renton: It is not only synthetic, but it shows, in the long-winded speeches with no content, the Opposition's lack of interest in series proposals for improving the NHS.

Mr. Alexander Eadie: Does the Patronage Secretary realise that, because of this announcement, he can be accused of mismanaging the business and procedures of the House? As there has already been some discussion with him through questions on what the nation will think about this, does he realise that he is giving food to the thought that this motion is not just about gagging Members of this House, but about gagging Members in his party because the Government suffered a bad defeat last night?
As this is a major piece of Government legislation and some of us were not privileged to serve on the Committee, how can we as Back Benchers have the opportunity to debate the many significant new clauses and amendments to the Bill which affect our constituents?
Finally, as his hon. Friend the Member for Tayside, North (Mr. Walker) confessed that the Conservative party was a minority party in Scotland, does the right hon. Gentleman realise that this motion will ensure that it remains a minority party in Scotland for a long time?

Mr. Renton: The hon. Gentleman is a senior and experienced Member of this House, and I am sure that he is trying to be helpful, but when he makes accusations of mismanagement, he should direct them at his own Front Bench. There was agreement between the usual channels that Report and Third Reading would take two and a half


days. In business questions last week, the only comment on that suggestion came from the hon. Member for Belfast., South (Rev. Martin Smyth), who expressed thanks for finding so much time. Between 5 am and 11.30 am, the hon. Member for Livingston (Mr. Cook), speaking from the Opposition Front Bench, took three hours and occupied nearly half the time available. If the hon. Gentleman thinks that that is serious discussion on the Bill, the hon. Member for Livingston, who is not even in his place, should be replaced by someone more serious.

Mr. Edward Leigh: Anybody who attended the 100-hour-long Committee, as I did, would have to accept that our debates were infinitely superior in terms of point and conciseness than the farce of the past 12 years—[Laughter.]—or rather, 12 hours. It felt like 12 years. Is it not partly due to the wounded pride of the hon. Member for Livingston (Mr. Cook), because of the temerity of my right hon. and learned Friend the Secretary of State in announcing publicly that the Committee had had a smooth ride and debated the issues sensibly? Given that the Opposition gave an undertaking to get the Bill through in two and a half days on Report, can we ever believe anything that they say again? Does this not underline the need for early guillotines in future?

Mr. Renton: I thank my hon. Friend for his sensible and brief comments. It was a Freudian slip that led him to refer to 12 years rather than to 12 hours, but many of us on both sides may agree that it felt like that. One must ask where the hon. Member for Livingston is. I suspect that he has left the House to give another television interview.

Mr. William Ross: Is the Patronage Secretary aware that, although my hon. Friend the Member for Belfast, South (Rev. Martin Smyth) expressed thanks for small mercies, the Unionist party is not in favour of guillotine motions, and we shall vote against this one as usual? May I put it to him that we are extremely disappointed that, when the opportunity occurred to rejig the rest of this week's business, the chance was not seized to discuss the decision of the Dublin Supreme Court and the Anglo-Irish Agreement, which vindicated the stance taken by the Unionist party, or to discuss the judgment handed down on extradition in the courts in Dublin yesterday, which can simply be translated as a licence to murder in Ulster?

Mr. Renton: I remind the hon. Gentleman of the precise words of the hon. Member for Belfast, South (Rev. Martin Smyth):
I welcome the fact that there is to be a two-and-a-half-day debate on the National Health Service and Community Care Bill."—[Official Report, Thursday 8 March; Vol. 168 c. 1014.]
The debate has not proceeded with due dispatch, simply because of the inordinately long speeches made, particularly from the Opposition Front Bench, rehashing comments that they had already made in Committee.
The hon. Gentleman is well versed in the procedures of the House. The question of the Irish judgment does not arise from the business statement. The question of a debate on that and, indeed, on other subjects, is best left for discussion through the usual channels.

Mr. Doug Hoyle: Does the Patronage Secretary realise that, because of the Government's action, we shall not have an opportunity to debate new clause 8 on the limitation of junior doctors'

hours in self-governing hospitals? Because of that, patients' lives could be put at risk if junior doctors must endure the long arduous hours that they are enduring now in many hospitals.

Mr. Renton: The hon. Gentleman should direct his remarks to his Opposition Front Bench spokesmen. If they curtail their speeches this afternoon and tomorrow, perhaps we will reach new clause 8.

Mr. George Foulkes: Why has not the Patronage Secretary given details of the timetable? As he has not given details, perhaps he will tell me whether there will be any time for me to raise the allegation that the Scottish Office is bribing consultants in South Ayrshire by saying that phase 2 of the new South Ayrshire hospital will go ahead faster if there is agreement to opt out of the National Health Service. Does he agree that we ought to have time to discuss that kind of disgraceful allegation? It reeks of corruption in the highest places in the Scottish Office.

Mr. Renton: I congratulate the hon. Gentleman on his success in making his point during the course of these questions on a business motion. He is an ingenious Member, who usually finds an opportunity to make any point that he wants to make. He knows the procedures of the House very well. As to the timetable motion, I repeat that it will appear on Wednesday's Order Paper, and during the debate on it these matters of detail may be raised with Ministers.

Mr. Ian Gow: Did my hon. Friend really believe that the agreement that had been reached through the usual channels would be honoured by the Opposition?

Mr. Renton: My hon. Friend and I might have a quiet discussion about that later, outside the Chamber.

Mr. Alex Salmond: Did the Patronage Secretary's business statement take fully into account the 100 Government amendments outstanding? I am sure that he is aware that, regardless of his power to restrict debate, he cannot restrict votes on those amendments. There is potential for 24 hours of voting. Would it not be better to devote that time to debate? Will he, rather than whining about the usual channels and about agreements made or not made, acknowledge that many Members and many parties in this House are not covered by the usual channels? How does his announcement today defend the rights of those Members who have been waiting to contribute to the debate?

Mr. Renton: The hon. Member, if he has studied the amendment paper carefully, will realise that the 83 Government amendments deal with drafting and technical matters. They are the ones about which there did not seem to be any dispute. There should be no need for substantive debate on them. However, as I have said, there will be plenty of time at the sittings on Wednesday and Thursday to consider these matters in detail.

Mr. John Battle: Will the Patronage Secretary acknowledge that the longest debate on this Bill so far was the one on new clause 1, which dealt with income support shortfall for people in residential homes? During that debate, Government Members took up more


time than Opposition Members. Can the Patronage Secretary guarantee that new clause 12 will be debated at length?
When the Secretary of State had replied last night, there was unfinished business on that clause. He promised that the House would return to it. This is obviously a matter of great concern to Members on both sides of the House, and it ought to be debated fully.

Mr. Renton: The hon. Gentleman is getting extremely indignant. I can only say to him what I have said to other hon. Members on both sides: the timetable motion will appear on Wednesday's Order Paper, and the House will have an opportunity, in the debate on that motion later today, to deal with this matter. I remind the hon. Gentleman that the two longest speeches in Tuesday's debate were the one by the hon. Member for Livingston (Mr. Cook), which lasted one hour and 48 minutes, and one that lasted one hour 11 minutes. If the hon. Member thinks that that is orderly progress in this House, I have to tell him that it is not my understanding of those words.

Mr. James Lamond: I imagine that it is with some sorrow that the Patronage Secretary is proposing a guillotine motion. Guillotines thwart the very purpose of Parliament. The right hon. Gentleman has based his proposal on the suggestion that the debates on this Bill have been over-long. I am sure that he was present last night when, within 10 minutes of the end of a fairly lengthy debate on new clause 1, it was necessary for one of his hon. Friends below the Gangway to get to his feet to ask for clarification of the awful things that the Government are proposing.
If ever there was an illustration of the fact that the debates have not been over-long—that the debates that we have had have been extremely necessary to bring to the attention of Government Members exactly what is happening—that was it. Unfortunately, the hon. Gentleman, having received a reply indicating that his thoughts were absolutely correct, did not carry his objection into the Lobby.

Mr. Renton: Perhaps it is no surprise to the hon. Gentleman to hear that I disagree with his interpretation of the events of the last 18 hours. Progress last night and this morning clearly showed that the Opposition are seeking to delay this Bill rather than to engage in sensible debate. It is always with regret that a Patronage Secretary as democratic as I am introduces a timetable motion, but, for the reason that I have just given, the motion is necessary. The House must be enabled to continue to make progress on this very important matter.

Mr. Andrew F. Bennett: Does the Patronage Secretary agree that the first affront to the House was to put Health Service legislation and community care legislation together? Can he confirm that very many people expected last year that there would be two separate Bills and two separate opportunities for debate? The second affront is the Government's introduction of a guillotine motion without telling us how much time will be allowed. Does not the Patronage Secretary realise that hon. Members and very many people outside who try hard to lobby their Members of

Parliament in respect of particular amendments are being denied the opportunity to allocate the remaining time rationally?

Mr. Renton: No one can make a souffle rise twice. The hon. Gentleman really should not rehash the argument about putting two Bills together. This matter was well ventilated, for example on Second Reading, for which we allowed two days—in itself, an unusually generous provision. As to the hon. Gentleman's other point, I repeat that he will be able to make it in detail when the timetable motion is debated and in further proceedings on Report. When business motions of this sort are tabled, it is not customary to give precise details of the timetable. Those appear on the Order Paper, as will happen on this occasion.

Mrs. Alice Mahon: The Patronage Secretary must be aware that many clauses and amendments that concern patient care will now not be debated fully. Many hon. Members hoped to raise the question of the deficits that their district health authorities are facing. In the case of the authority in my area, the figure is£1·2 million. That will lead to a massive loss in patient care, to ward closures and to many other difficulties that will cause suffering and inconvenience to the people of Halifax would have been grateful to my hon. Friend the Member for Livingston (Mr. Cook) had he talked from now until next week, if that had given us a chance to bring to the attention of the House the great suffering that these cuts will inflict on them? The hon. Gentleman's trivialisation of the debates that have taken place does neither him nor his party any good.

Mr. Renton: Obviously, the hon. Lady ought to direct her remarks to the hon. Member for Livingston. She says that she would have been content had he spoken from now until next week. Clearly, in those circumstances it would have been impossible to restrict the debate to the two and a half days that were agreed and accepted by the House during business questions last week.

Mr. Tom Clarke: On a point of order, Mr. Speaker. As those on the Opposition Front Bench had been attacked several times by the Chief Whip, it ought to be made quite clear that there never was an agreement on two and a half days. The Government did not give us two and a half days. The Government lost again last night, and today they have run away with the ball.

Mr. Speaker: I have no knowledge of what goes on in the usual channels.

Mr. Harry Barnes: This is my first chance to say anything during the entire proceedings on the Bill. I believed that I would have an opportunity later to get involved in the debate. Why is it that, presumably, I will not be allowed to speak during the course of the proceedings on the 108 amendments that could still be taken? And if I am not allowed to speak, why will I not be allowed to vote?
I was voted into this House by people in my constituency, and they expect me to be able to vote on their behalf on these important matters. Will we be given a chance to go through the amendments, so that we may at least have an opportunity to exercise our right to go through the Division Lobbies?

Mr. Renton: I note the hon. Gentleman's enthusiasm. He has had a number of occasions on which to vote during the past 20 hours and I am sure that he will have other occasions on which to vote in the hours ahead.

Ms. Dawn Primarolo: I am sure that the Patronage Secretary is aware, because this point has been made during the debate, that there are 11 district health authorities in the south-west, of which eight in their entirety are to be removed as trusts in the first wave. As a member of a district health authority, I know that the care services for the mentally ill and the physically disabled and the priorities for community care have not yet been dealt with. Will the right hon. Gentleman guarantee that we shall have adequate time to discuss the items raised under community care? In that way, some guidance can be given to the district health authorities which are opting out and at present making no provision.

Mr. Renton: As the hon. Lady well realises, it is not in my power to give the guarantee that she seeks. Whether there is an opportunity to raise those detailed points about the south-west depends very much on the length of the speeches made in the debate on the timetable motion and during the remainder of the Report stage.

Mr. Bob Cryer: At the beginning of the debate on the timetable motion, will the right hon. Gentleman include a section for what might be called sleaze time? This information was not discussed overnight, although it was circulated. It concerns the four companies—P and O, British and Commonwealth, Trusthouse Forte and BET—which, since 1983, have given more than £1 million to the Conservative party. We could also discuss the 22 Conservative Members who have shares in those various companies. There has been some dispute—which we should clear up—as to whether those Members should be allowed to vote. They certainly would not be allowed to vote in local authorities, so why should they be allowed to vote here?

Mr. Renton: The hon. Gentleman has a natural aptitude for raising matters concerned with sleaze. Whether there is time to debate those points on Wednesday or Thursday obviously depends on the length of speeches made by him and others of his hon. Friends during the debate.

Mr. Dennis Skinner: Is not the real reason why the Patronage Secretary has come to the House today the fact that the Government are crumbling at the edges, as witnessed by their defeat last night and the absconding of the Secretary of State for Wales? Where is the Leader of the House? Has he done a bunk as well? The Government are rotting at the centre. They do not want to debate these issues because they do not want those 22 Tory Members to be named in the debate. What is wrong with debating between now and Sunday night? If hospital doctors have to work for 80-odd hours on their own, why cannot Members of Parliament work? Stop the cover-up.

Mr. Renton: The hon. Gentleman has a marvellous capacity for fantasy, which never ceases to amuse and delight both sides of the House, although I sometimes wonder how much his constituents like it. We will have business questions tomorrow, and perhaps the hon.

Gentleman will then tell us when we shall have an opportunity to debate the conduct of the 32 Labour Members who are leading a campaign not to pay the poll tax, and when the leader of the Labour party is going to put the boot where his mouth is and remove the Labour whip from those Members.

Mr. Harry Ewing: Is the right hon. Gentleman aware that his normal good humour is wearing a bit thin, and he is certainly looking the worse for wear? Is he aware that, if all these rumours about the new Secretary of State for Wales are true, we in Scotland will be bitterly disappointed? We had hoped to get rid of the Secretary of State for Scotland, and thought that he had a chance of getting that job.
On the business statement, why did not the Patronage Secretary take the opportunity to correct the history knowledge of the hon. Member for Rockburgh and Berwickshire (Mr. Kirkwood), who said that the National Health Service Act 1946 was an agreed measure? Why did not the right hon. Gentleman tell him that the Tory Opposition voted against its Second Reading and fought it line by line? Is not the guillotine which has been announced evidence that the Health Service is not safe in the hands of the Conservative party and that, in fact, a guillotine looms over it?

Mr. Renton: I thank the hon. Gentleman for his sympathy. On listening to him, my good humour returned. I should like to point out, however, that he has a selective memory. As I said to the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood), the Health Services Act 1976—a Labour Act—spent only 80 hours in Committee. The debate in Committee was then guillotined, as were the Report stage and Third Reading, and the timetable motion was introduced after only 42 hours. If the hon. Gentleman compares that disgraceful Labour record with ours, I am sure that he will join me in thanking Conservative Ministers for the democracy that they are showing and for their care for the procedures of the House.

Mr. Campbell-Savours: So that the public clearly understand what is happening in the House of Commons, will the Patronage Secretary confirm that we are now required to debate more than 108 amendments and new clauses in five and a half hours, whereas last night the Government were prepared to give six hours to one clause? Cannot the public rightfully ask why the Government are willing to give six hours to one new clause but only five and a half hours to a further 108 measures?
Could it be that one of those measures would give us the opportunity to discuss the sleaze factor, to which my hon. Friend the Member for Bradford, South (Mr. Cryer) referred—that is, give us the opportunity to expose the relationship between Conservative Members and private contractors who hope to act as parasites living on the back of the NHS following this legislation?

Mr. Renton: As I said in answer to the hon. Member for Bradford, South (Mr. Cryer), the hon. Gentleman has a natural attraction to sleaze. If he wishes to discuss that matter during the Bill's later stages and the Opposition make short speeches, he will have an opportunity to do so. I agree that progress during the night was too slow. We shall introduce a timetable motion so that reasonable progress can be made.

Orders of the Day — Points of Order

Mr. Ray Powell: On a point of order, Mr. Speaker. My point of order, which I tried to raise earlier, is relevant, because it deals with the National Health Service and Community Care Bill. One of the Bill's sponsors is none other than the right hon. Member for Worcester (Mr. Walker). We now know from the tape and from the Patronage Secretary that the right hon. Gentleman's successor has been appointed. Would it not therefore be in order for the Bill to be withdrawn because one of its sponsors has resigned? I understand that he has resigned, without making a statement to the House, in order to become chairman of PowerGen.
As I said earlier, I raised this matter on points of order on three previous occasions and during business questions on Thursday in the hope that a statement would be made so that we in Wales could ask the Secretary of State for Wales why he was resigning. We had a six-hour Welsh debate, yet the right hon. Gentleman did not declare his intention of resigning to take up the job as chairman of PowerGen. I think that it comes within your ambit, Mr. Speaker, for you to ask Ministers and the Patronage Secretary why appointed Ministers should not declare to the House their reason for resigning.

Several Hon. Members: rose——

Mr. Speaker: Order. Let me deal with one thing at a time. The right hon. Member for Worcester (Mr. Walker) was the Secretary of State for Wales when the Bill was printed and, as far as I am aware, he is still the Secretary of State for Wales. I have no knowledge of any other job that he may or may not have been offered, so as far as I am concerned that point does not arise.

Mr. Barry Jones: Further to the point of order, Mr. Speaker. I seek your assistance and guidance concerning the appointment of a new Secretary of State for Wales. In the Welsh Grand Committee, which sat this morning, the right hon. Member for Worcester (Mr. Walker) gave us no details of the situation whatever so we are not sure whether the right hon. Gentleman is still the Secretary of State for Wales. That is why we seek your help, Sir. Can you bring the Patronage Secretary to the Dispatch Box to make a statement giving us all the details, to enable us to establish whether it is true that the Minister for the poll tax has been selected to take the place of the right hon. Member for Worcester?

Mr. Speaker: I have absolutely no knowledge of these matters, and they are not matters for me.

Mr. Dafydd Wigley: I, too, was present at this morning's sitting of the Welsh Grand Committee, when the Secretary of State for Wales—until now—said that he knew nothing of a statement having been made concerning the appointment of his successor. Yet a few moments ago, the Patronage Secretary not only referred to the new Secretary of State for Wales but commended him to the House, so he at least must know who it is to be.
We do not know whether we have no Secretary of State for Wales, one or other, or two at the same time. That is a completely unsatisfactory state of affairs, given that that matter is vital to us in Wales.

Mr. Speaker: That is not a matter that can be raised on a point of order in the Chamber. I have absolutely no knowledge of these matters.

Mr. Nigel Spearing: On a point of order, Mr. Speaker, you will recall that I asked the Patronage Secretary to give us more details of the time that would be allowed if the timetable motion were carried. I pointed out that it would be possible for that timetable motion to give us a further 18 hours of debate on the 30 remaining new clauses and matters related to them, which affect everyone in the country. When I went to the Table Office immediately afterwards, I found deposited there the timetable motion whose details the Patronage Secretary had uncharacteristically declined to reveal to the House. It was public knowledge to hon. Members in the Table Office, but not in the Chamber.
If the timetable motion is carried, we shall have until midnight tonight—Wednesday—to debate these matters. That gives us a maximum of six hours. Would it be in order, Mr. Speaker, for the Patronage Secretary to discharge his duties to democracy and to the House and follow the precept that he mentioned in his reply to me? Could he, during the Adjournment debate, table a different timetable motion giving us three times as long—until midday on Thursday—to debate these very important new clauses?

Mr. Speaker: It would be in order for the Patronage Secretary to do that if he so wished, provided that the motion appeared on the Order Paper before we began Wednesday's proceedings.

Several Hon. Members: rose——

Mr. Speaker: Order. I will now take Mr. Alton's petition.

Mr. James Wallace: On a point of order, Mr. Speaker.

Mr. Speaker: What can the point of order possibly be after all that?

Mr. Wallace: You will recall, Mr. Speaker, that, about a quarter of an hour ago, the Patronage Secretary said that, tomorrow, we should debate a motion to amend schedule 1 to the House of Commons Disqualification Act 1975——

Mr. Speaker: Order. Was the hon. Gentleman not here during questions to the Patronage Secretary? Surely he could have asked his question of the right hon. Gentleman then.

Mr. Wallace: It is your guidance that I seek, Mr. Speaker. During the points of order that followed the business statement, the hon. Member for Ogmore (Mr. Powell) said that the right hon. Member for Worcester (Mr. Walker) was about to take up a position as the chairman of PowerGen. Suppose that that is established before tomorrow evening. From 31 March, PowerGen shares will be held by the Government. Does that mean that the chairmanship will become an office of appointment under the Crown, and will it be relevant to debate that tomorrow evening?

Mr. Speaker: That is a very interesting point, I am sure.

Several Hon. Members: rose——

Mr. Speaker: Let us have the petition now.

Mr. Bob Cryer: On a point of order, Mr. Speaker. The guillotine arrangements that we shall be following later today and tomorrow, will not be in the Vote Office before the House adjourns. In view of that very short notice, will you be accepting manuscript amendments, as that would be most helpful?

Mr. Speaker: I shall certainly consider them most carefully.

Several Hon. Members: rose——

Mr. Speaker: I will take one more point of order, from the hon. Member for East Lothian (Mr. Home Robertson).

Mr. John Home Robertson: On a quick point of order, Mr. Speaker, I was very perplexed by something that the hon. Member for Caernarfon (Mr. Wigley) said. He said that he had attended a sitting——

Mr. Speaker: Order. The fact that an hon. Member is perplexed by what another hon. Member has said is not a point of order. I am constantly perplexed.

Mr. Home Robertson: I seek clarification from you, Mr. Speaker. The hon. Member for Ogmore said that he was present at a sitting of the Welsh Grand Committee this morning. Surely that is impossible. He must have been there tomorrow morning.

Mr. Speaker: I think that I can indeed clarify that matter——

Mr. Wigley: rose——

Mr. Speaker: No, let me have the first go. It is Wednesday upstairs in Committee, but it may be Tuesday down here.

Mr. Wigley: On a point of order, Mr. Speaker. On the question of the appointment of the Secretary of State for Wales, I realise that you have very little power in this matter, but the Government have been unforthcoming and have made no statement. The circumstances are completely different from those that usually pertain. Usually when a Secretary of State resigns, the job becomes empty and we have an announcement from Downing Street. In this case, an announcement has been made while there is an incumbent in the job. Once again, we have strangers in Wales taking over the jobs. In those circumstances, as I have in the past, I beg to move, That strangers do withdraw.

Notice being taken that strangers were present. MR. SPEAKER, pursuant to Standing Order No. 143 ( Withdrawal of Strangers from the House), put forthwith the Question,

That strangers do withdraw:—

The House proceeded to a Division—

Mr. Speaker: I direct the Serjeant at Arms to inquire why there is a delay in the Division Lobbies.

The House having divided: Ayes 2, Noes 190.

Division No. 122]
[1.06 pm


AYES


Jones, leuan (Ynys Môn)
Tellers for the Ayes:


Thomas, Dr Dafydd Elis
Mr. Alex Salmond and



Mr. Dafydd Wigley.





NOES


Adams, Allen (Paisley N)
Harris, David


Alton, David
Hayhoe, Rt Hon Sir Barney


Amess, David
Haynes, Frank


Arnold, Jacques (Gravesham)
Hind, Kenneth


Arnold, Tom (Hazel Grove)
Hogg, Hon Douglas (Gr'th'm)


Ashton, Joe
Home Robertson, John


Atkins, Robert
Hood, Jimmy


Baker, Rt Hon K. (Mole Valley)
Hordern, Sir Peter


Baker, Nicholas (Dorset N)
Howarth, Alan (Strat'd-on-A)


Barnes, Harry (Derbyshire NE)
Howarth, George (Knowsley N)


Barron, Kevin
Howells, Geraint


Battle, John
Howells, Dr. Kim (Pontypridd)


Beggs, Roy
Hoyle, Doug


Beith, A. J.
Hughes, John (Coventry NE)


Bellingham, Henry
Hughes, Roy (Newport E)


Benn, Rt Hon Tony
Hughes, Sean (Knowsley S)


Bennett, A. F. (D'nt'n &amp; R'dish)
Irvine, Michael


Bennett, Nicholas (Pembroke)
Jackson, Robert


Bermingham, Gerald
Jones, Gwilym (Cardiff N)


Boswell, Tim
Jones, Martyn (Clwyd S W)


Bottomley, Mrs Virginia
Kellett-Bowman, Dame Elaine


Bright, Graham
Key, Robert


Brown, Michael (Brigg &amp; Cl't's)
Kilfedder, James


Buck, Sir Antony
King, Roger (B'ham N'thfield)


Butcher, John
Kirkwood, Archy


Butler, Chris
Knight, Greg (Derby North)


Campbell, Ron (Blyth Valley)
Knight, Dame Jill (Edgbaston)


Chalker, Rt Hon Mrs Lynda
Knox, David


Churchill, Mr
Lamond, James


Clark, Dr David (S Shields)
Lawson, Rt Hon Nigel


Clark, Sir W. (Croydon S)
Lee, John (Pendle)


Clwyd, Mrs Ann
Leigh, Edward (Gainsbor'gh)


Cohen, Harry
Lennox-Boyd, Hon Mark


Colvin, Michael
Lester, Jim (Broxtowe)


Conway, Derek
Lewis, Terry


Cook, Frank (Stockton N)
Livingstone, Ken


Coombs, Anthony (Wyre F'rest)
Livsey, Richard


Corbett, Robin
Lloyd, Sir Ian (Havant)


Cryer, Bob
Lloyd, Peter (Fareham)


Currie, Mrs Edwina
Loyden, Eddie


Curry, David
McCartney, Ian


Dalyell, Tam
McFall, John


Davis, David (Boothferry)
McKay, Allen (Barnsley West)


Dewar, Donald
MacKay, Andrew (E Berkshire)


Dickens, Geoffrey
McKelvey, William


Dixon, Don
Maclean, David


Dorrell, Stephen
Mans, Keith


Douglas, Dick
Martin, David (Portsmouth S)


Douglas-Hamilton, Lord James
Martin, Michael J. (Springburn)


Duffy, A. E. P.
Maxwell-Hyslop, Robin


Dunn, Bob
Meale, Alan


Dunnachie, Jimmy
Meyer, Sir Anthony


Eadie, Alexander
Michie, Mrs Ray (Arg'l &amp; Bute)


Eastham, Ken
Mills, Iain


Ewing, Harry (Falkirk E)
Mitchell, Andrew (Gedling)


Fallon, Michael
Moate, Roger


Favell, Tony
Morgan, Rhodri


Fearn, Ronald
Morris, Rt Hon A. (W'shawe)


Fenner, Dame Peggy
Moynihan, Hon Colin


Flynn, Paul
Murphy, Paul


Forman, Nigel
Neubert, Michael


Forsyth, Michael (Stirling)
Nicholls, Patrick


Forth, Eric
Nicholson, Emma (Devon West)


Foster, Derek
O'Brien, William


Foulkes, George
Orme, Rt Hon Stanley


Franks, Cecil
Pike, Peter L.


Freeman, Roger
Porter, Barry (Wirral S)


Gale, Roger
Porter, David (Waveney)


Garel-Jones, Tristan
Quin, Ms Joyce


Golding, Mrs Llin
Raffan, Keith


Gorman, Mrs Teresa
Renton, Rt Hon Tim


Gorst, John
Rhodes James, Robert


Graham, Thomas
Rogers, Allan


Grant, Sir Anthony (CambsSW)
Ross, William (Londonderry E)


Griffiths, Peter (Portsmouth N)
Rossi, Sir Hugh


Griffiths, Win (Bridgend)
Rowe, Andrew


Grist, Ian
Ruddock, Joan


Hamilton, Hon Archie (Epsom)
Rumbold, Mrs Angela


Hamilton, Neil (Tatton)
Sackville, Hon Tom






Sayeed, Jonathan
Wallace, James


Scott, Rt Hon Nicholas
Waller, Gary


Shepherd, Colin (Hereford)
Wardell, Gareth (Gower)


Shore, Rt Hon Peter
Wareing, Robert N.


Sillars, Jim
Wheeler, Sir John


Skeet, Sir Trevor
Widdecombe, Ann


Skinner, Dennis
Williams, Rt Hon Alan


Speller, Tony
Williams, Alan W. (Carm'then)


Spicer, Michael (S Worcs)
Winterton, Nicholas


Stewart, Andy (Sherwood)
Wise, Mrs Audrey


Stokes, Sir John
Wolfson, Mark


Stradling Thomas, Sir John
Wood, Timothy


Summerson, Hugo
Woodcock, Dr. Mike


Taylor, Mrs Ann (Dewsbury)
Young, David (Bolton SE)


Temple-Morris, Peter
Young, Sir George (Acton)


Thompson, D. (Calder Valley)



Thornton, Malcolm
Tellers for the Noes:


Thurnham, Peter
Mr. John M. Taylor and Mr. David Lightbown.


Walker, Bill (T'side North)

Question accordingly negatived.

Several Hon. Members: On a point of order, Mr. Speaker.

Mr. Speaker: Order. I shall take one point of order from the hon. Member for Merthyr Tydfil and Rhymney (Mr. Rowlands).

Mr. Ted Rowlands: On a point of order, Mr. Speaker. As this was the first time that that question was put to the House since the television cameras were introduced, if it had been carried, would the television cameras have been shut off? Would the cameras be strangers?

Mr. Speaker: If that had occurred, I confirm that that would have been the case—the cameras would be shut off.

Several Hon. Members: rose——

Mr. Speaker: Order. I am not taking any more points of order. I now call Mr. David Alton to present his petition.

Mr. Dennis Skinner: rose——

Mr. Speaker: Order. I will not take the hon. Gentleman's point of order.

Mr. Skinner: I am moving the writ for Upper Bann.

Mr. Speaker: I order the hon. Gentleman to resume his seat.

Mr. Skinner: According to "Erskine May"—

Mr. Speaker: I have already asked the hon. Gentleman to resume his seat. I call Mr. David Alton.

Orders of the Day — PETITION

Local Government Finance

Mr. David Alton: At the end of this 23-hour marathon session of the House I am pleased to have the opportunity to present a petition that has been collected by my constituents in the Wavertree, Edge Hill and Smithtown areas of the city of Liverpool.
I could mention many of the streets included in the petition, but I am sure that the House would not wish to be detained. [HON. MEMBERS: No. Name them."] Many hundreds of people in those areas have asked me to present the petition on their behalf detailing their concern about the implementation of the community charge, the poll tax. I am sure that the House would wish to hear the terms of reference of the petition. It reads, in the time-honoured way:
To the Honourable the Commons of the United Kingdom of Great Britain and Northern Ireland in Parliament assembled.
The humble petition of the residents of Smithtown ward in Liverpool showeth that this community rejects the poll tax as a unfair law and notes that many people in this community will face grave difficulty in paying the charge.
Wherefore your Petitioners pray that your Honourable House will replace the community charge with a fair and equitable means of local government finance that truly reflects a persons ability to pay.
And your petitioners in duty bound will ever pray.
I should like to take this opportunity——

Mr. Speaker: Order. The hon. Gentleman may not make a speech about it. He must present his petition.

Mr. Alton: I believe that it is normal for one or two sentences to be said——

Mr. Speaker: Prior to reading what the hon. Gentleman has just read out.

Mr. Alton: I should like to take the opportunity to congratulate the organiser of the petition, Mr. Peter McGrath. Responsible opposition of this sort highlights the acute anxieties that many people in under privileged parts of the country, such as the community that I have represented for 18 years in Liverpool——

Mr. Speaker: Order. The rule is that the hon. Gentleman should make any preparatory remarks before he reads out the petition. He has read it out. Will he please put it in the bag?

Orders of the Day — Gynaecology (Privacy)

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Dorell.]

Miss Emma Nicholson: rose—

Mr. Dennis Skinner: I have got the writ here for Upper Bann.

Miss Nicholson: The purpose of the debate is to restore to women the dignity and privacy on gynaecological matters that the new—[Interruption.]

Mr. Speaker: Order.

Mr. Allan Rogers: The hon. Member for Liverpool, Mossley Hill (Mr. Alton) has not presented his petition.

Mr. Speaker: Order. I call on the hon. Gentleman to put his petition in the bag. Miss Nicholson.

Miss Nicholson: The purpose of the debate is to restore to women the dignity and privacy that the new GPs' contract has inadvertently removed.

Several Hon. Members: On a point of order, Mr. Speaker.

Mr. Speaker: Order. We are in the middle of the Adjournment debate.

Several Hon. Members: rose—

Mr. Speaker: Order. Hon. Members should sit down, as we are in the middle of the Adjournment debate—[Interruption.]

Grave disorder having arisen in the House, Mr. Speaker, pursuant to Standing Order No. 26 (Power of Mr. Speaker to adjourn House or suspend sitting), adjourned the House without Question put.

Adjourned at Twenty-nine minutes past one pm.